Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review

Jennifer E Isenor; Isaac Bai; Rachel Cormier; Melissa Helwig; Emily Reeve; Anne Marie Whelan; Sarah Burgess; Ruth Martin-Misener; Natalie Kennie-Kaulbach

doi:10.1016/j.sapharm.2020.09.005

Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review

Res Social Adm Pharm. 2021 Jul;17(7):1229-1241. doi: 10.1016/j.sapharm.2020.09.005. Epub 2020 Sep 22.

Authors

Jennifer E Isenor¹, Isaac Bai², Rachel Cormier², Melissa Helwig³, Emily Reeve⁴, Anne Marie Whelan², Sarah Burgess⁵, Ruth Martin-Misener⁶, Natalie Kennie-Kaulbach²

Affiliations

¹ College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada. Electronic address: jennifer.isenor@dal.ca.
² College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada.
³ W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada.
⁴ College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada; Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada.
⁵ Pharmacy Department, Nova Scotia Health Authority, Halifax, NS, Canada.
⁶ School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, Canada.

PMID: 32978088
DOI: 10.1016/j.sapharm.2020.09.005

Abstract

Background: Polypharmacy 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.

Objective: This scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW).

Methods: A 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).

Results: Searches 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.

Conclusions: Deprescribing 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.

Keywords: Behaviour change wheel; Deprescribing; Primary health care.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Deprescriptions*
Humans
Pharmacists
Polypharmacy
Primary Health Care