Key points
communicating, and coordinating with the patient
and in concert with the care of other clinicians; and,
(4) monitoring the patient for beneficial or harmful
effects.” Pharmacists are well placed to monitor
patient’s long term and should be involved in the
deprescribing process. 39
Barriers
Barriers to deprescribing include understanding of
the evidence of harm from side effects versus the
benefit of discontinuing medications. Within the
UK, there is a lack of guideline recommendations
and a robust evidence base to demonstrate benefit
versus risk. 40,41 The NICE guideline on clinical
assessment and management of multimorbidity
provides some guidance regarding the review of
medication and recommends the use of screening
tools, such as STOPP/START (see Table 2). 42,43
Prescribers working within different healthcare
environments might approach deprescribing from
different viewpoints. GPs might be reluctant to
withdraw medicines initiated in secondary care by
a ‘specialist’ as such, and these medications might
not undergo review. 16
Within secondary/ambulatory care, concerns
over poor outcomes/symptom relapse following the
withdrawal of a medication may hinder a proactive
approach to deprescribing. 41 Deprescribing is an
area where the evidence is currently evolving and
there are concerns that the lack of evidence would
not support the decision to stop a specific medicine.
The absence of guidelines regarding support and
management of the multimorbid, frail and elderly
patient can make the management of these patients
difficult. The lack of defined guidelines leads to fear
of repercussions should the patient suffer an adverse
event following deprescribing and clinicians are
therefore more reluctant to deprescribe. 44
The process of deprescribing will also involve
managing patients’ perceptions and expectations.
As with all clinical decisions, patients must be
informed and take active participation in the
decision to deprescribe. The benefits of doing
so should be fully explained to both the patient
and their carers, and reassurance given that
treatments can be reintroduced if deemed clinically
appropriate. 44,45
The act of stopping a drug goes against the
expectation of some patients, who generally want
‘a pill for every ill’, and it is easier to prescribe
something rather than deprescribe because
deprescribing comes with potential risks to
• Optimal
pharmacological
management of an
ageing population
presents challenges due
to their complex health
and social care needs
in addition to often-
complicated treatment
regimes that increase
their medication burden.
The latter accounts for
up to 5–6% of all adult
emergency admissions to
hospital secondary to an
adverse drug event.
• Deprescribing
is 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.”
• Deprescribing is a
useful tool when applied
appropriately to the
right patient; however,
there are barriers to its
uptake that should be
acknowledged.
• Pharmacists
are well placed to
support and initiate
deprescribing, with high
acceptance rates when
working as part of a
multidisciplinary team.
• The long-term impact
of deprescribing is
yet to be quantified
and demonstrates
the need for further
research into this area.
The development of
guidelines to support
clinicians in making
a clinical assessment
in the context of
deprescribing would
help to standardise the
process and also act as
a useful tool to support
prescribers.
hospitalpharmacyeurope.com | 2018 | Issue 90 | 23