Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review |
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| Authors: | Jennifer E. Isenor Isaac Bai Rachel Cormier Melissa Helwig Emily Reeve Anne Marie Whelan Sarah Burgess Ruth Martin-Misener Natalie Kennie-Kaulbach |
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| Affiliation: | 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia;2. Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia;3. Medical and Cognitive Research Unit, Austin Health, Heidelberg, Victoria, Australia;1. Pharmacy Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom;2. The University of Manchester, United Kingdom;1. Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada;2. Department of Family Medicine, University of Ottawa, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada;3. School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario N2G 1C5, Canada;4. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada;5. School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, Ontario K1N 6N5, Canada;6. Department of Applied Human Sciences, Concordia University, 1455 de Maisonneuve Blvd. West, Montreal, Quebec H3G 1M8, Canada;1. College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, 750 McDermot Avenue, Winnipeg, Manitoba, R3E 0T5, Canada;2. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada;3. Bruyère Research Institute, 43 Bruyère St., Ottawa, Ontario, K1N 5C8, Canada;4. Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada;5. School of Pharmacy, University of Waterloo, Waterloo, Canada;6. Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 3-171 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada;1. Continuing and Community Care Department, Tan Tock Seng Hospital, Singapore;2. School of Pharmacy, Monash University Malaysia, Selangor, Malaysia;3. National Healthcare Group Pharmacy, Singapore;4. Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia;5. School of Pharmacy, Taylor''s University Lakeside Campus, Subang Jaya, Selangor, Malaysia |
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| Abstract: | ![]()
BackgroundPolypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review.ObjectiveThis scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW).MethodsA scoping review was conducted that involved searches of six databases (2002–2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT).ResultsSearches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion.ConclusionsDeprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care. |
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| Keywords: | Deprescribing Primary health care Behaviour change wheel |
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