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Barriers and facilitators of implementing proactive deprescribing within primary care: a systematic review

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.

Publication metadata

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


DOI: 10.1093/ijpp/riad001


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