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Lookup NU author(s): Dr Daniel OkeowoORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
AbstractObjectiveProactive deprescribing – identifying and discontinuing medicines where harms outweigh benefits – can minimise problematic polypharmacy, but has yet to be implemented into routine practice. Normalisation process theory (NPT) can provide a theory-informed understanding of the evidence base on what impedes or facilitates the normalisation of routine and safe deprescribing in primary care. This study systematically reviews the literature to identify barriers and facilitators to implementing routine safe deprescribing in primary care and their effect on normalisation potential using NPT.PubMed, MEDLINE, Embase, Web of Science, International Pharmaceutical Abstracts, CINAHL, PsycINFO and The Cochrane Library were searched (1996–2022). Studies of any design investigating the implementation of deprescribing in primary care were included. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used to appraise quality. Barriers and facilitators from included studies were extracted and mapped to the constructs of NPT.Key findingsA total of 12,027 articles were identified, 56 articles included. In total, 178 barriers and 178 facilitators were extracted and condensed into 14 barriers and 16 facilitators. Common barriers were negative deprescribing perceptions and suboptimal deprescribing environments, while common facilitators were structured education and training on proactive deprescribing and utilising patient-centred approaches. Very few barriers and facilitators were associated with reflexive monitoring, highlighting a paucity of evidence on how deprescribing interventions are appraised.SummaryThrough NPT, multiple barriers and facilitators were identified that impede or facilitate the implementation and normalisation of deprescribing in primary care. However, more research is needed into the appraisal of deprescribing post-implementation.
Author(s): Okeowo D, Zaidi STR, Fylan B, Alldred D
Publication type: Article
Publication status: Published
Journal: International Journal of Pharmacy Practice
Year: 2023
Volume: 31
Issue: 2
Pages: 126–152
Print publication date: 01/04/2023
Online publication date: 01/03/2023
Acceptance date: 05/01/2023
Date deposited: 04/07/2023
ISSN (print): 0961-7671
ISSN (electronic): 2042-7174
Publisher: Oxford Academic
URL: https://doi.org/10.1093/ijpp/riad001
DOI: 10.1093/ijpp/riad001
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