Content area
Full text
Correspondence to Dr Rupert Payne, Centre for Academic Primary Care, University of Bristol, Office 1.01a, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; [email protected]
EAHP Statement 6: Education and Research
Introduction
Deprescribing has been defined as ‘the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’.1 This is particularly relevant to patients with polypharmacy (the prescription of multiple medications) because the risk of harm caused by medication increases with the number of medications a patient is prescribed.2 Stopping or reducing the dose of medications requires careful clinical consideration, with a need to balance issues such as potential loss of clinical benefit and increased patient anxiety, against reductions in medication errors, adverse reactions and prescribing burden. To reflect these complexities and sensitivities, the term ‘deprescribing’ has been adopted rather than simply stopping medicines. This requires similar levels of skill to prescribing in the first place.
This narrative review examines the issue of deprescribing from the perspective of primary care. In the UK, the general practitioner (GP) is the first point of contact with the health service for most patients, and gatekeeper to specialist services. Virtually all UK residents are registered with a GP as part of the state-funded National Health Service, and the management of long-term conditions, including prescription of long-term medications, is mostly managed in this setting. We present personal expert opinion supported by a search of the academic literature based around the term ‘deprescribing’ and key policy documents.
The purpose of this review is to (i) describe trends in polypharmacy and explanations for why it is increasing; (ii) outline the harms associated with overtreatment; (iii) outline the rationale for deprescribing and different approaches to deprescribing within general practice, including the role of the pharmacist; (iv) outline the barriers and enablers to deprescribing; and (v) make recommendations for future practice.
Trends in polypharmacy
Polypharmacy is a global issue, affecting developed and developing nations (table 1). The prevalence of polypharmacy within the UK is increasing—in Scotland, the proportion of patients prescribed ≥5 medications doubled to 20.8% from 1995 to 2010, and the proportion prescribed ≥10 medications tripled to 5.8% over the same period (see table 1).3 A similar...