Article date: December 2018
By: Christina R. Hansen, Denis O'Mahony, Patricia M. Kearney, Laura J. Sahm, Shane Cullinan, C.J.A. Huibers, Stefanie Thevelin, Anne W.S. Rutjes, Wilma Knol, Sven Streit, Stephen Byrne in Volume 84, Issue 12, pages 2716-2728
Aims
Deprescribing interventions safely and effectively optimize medication use in older people. However, questions remain about which components of interventions are key to effectively reduce inappropriate medication use. This systematic review examines the behaviour change techniques (BCTs) of deprescribing interventions and summarizes intervention effectiveness on medication use and inappropriate prescribing.
Methods
MEDLINE, EMBASE, Web of Science and Academic Search Complete and grey literature were searched for relevant literature. Randomized controlled trials (RCTs) were included if they reported on interventions in people aged ≥65 years. The BCT taxonomy was used to identify BCTs frequently observed in deprescribing interventions. Effectiveness of interventions on inappropriate medication use was summarized in meta‐analyses. Medication appropriateness was assessed in accordance with STOPP criteria, Beers' criteria and national or local guidelines. Between‐study heterogeneity was evaluated by I‐squared and Chi‐squared statistics. Risk of bias was assessed using the Cochrane Collaboration Tool for randomized controlled studies.
Results
Of the 1561 records identified, 25 studies were included in the review. Deprescribing interventions were effective in reducing number of drugs and inappropriate prescribing, but a large heterogeneity in effects was observed. BCT clusters including goals and planning; social support; shaping knowledge; natural consequences; comparison of behaviour; comparison of outcomes; regulation; antecedents; and identity had a positive effect on the effectiveness of interventions.
Conclusions
In general, deprescribing interventions effectively reduce medication use and inappropriate prescribing in older people. Successful deprescribing is facilitated by the combination of BCTs involving a range of intervention components.
DOI: 10.1111/bcp.13742
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