A new study led by Monash University has revealed that more than two thirds (71 per cent) of clinical practice guidelines do not contain any guidance on deprescribing - the process by which people reduce the dose of a medication, or work toward stopping altogether.
Clinical practice guidelines contain recommendations on how health practitioners should both diagnose and treat medical conditions, as well as prescribe medicines. As the potential benefits and harms of medicines can change for each individual over time, medication reviews and deprescribing guidance should be considered an essential part of the prescribing process.
Instead, the research team found only 29 per cent of guidelines contained a deprescribing recommendation. Furthermore, of the 80 guidelines that they found which included deprescribing recommendations, most did not have detailed information on how to deprescribe.
The study, published in the British Medical Journal (BMJ) Quality and Safety and led by the Centre for Medicine Use and Safety (CMUS) within the Monash Institute of Pharmaceutical Sciences, identified guidelines from Europe, North America, Australia, Asia and Africa published in the last 10 years.
Despite the vast range in demographics and healthcare systems, insufficient deprescribing recommendations were found to be a universal trend.
Co-first author and CMUS Research Fellow, Dr Aili Langford, said while medicines have many important benefits in curing and preventing diseases, along with improving symptoms, the findings of this review highlight a glaring omission in clinical practice guidelines internationally.
“While deprescribing recommendations are becoming more common, which is encouraging to see, what stood out is the need for greater clarity and specificity in these recommendations. If recommendations are unclear, they are unlikely to be implemented as intended," Dr Langford said.
“The potential benefits and harms of medicines can change over time as a person ages, acquires new medical conditions, takes new medicines and changes their care goals. Therefore, medicines should be regularly reviewed to make sure that they are still of benefit, and not causing harm.”
In Australia, around 400,000 people present to emergency departments each year because of medication-related problems, with at least 50 per cent of this harm deemed preventable. The issue is further inflated for people living in aged care facilities, where more than 95 per cent have at least one problem with their medicines detected at the time of a medicines review.
Co-first author Imaan Warriach, a research student from University College London who worked at CMUS while conducting the research, said at a societal level, deprescribing plays an important role in reducing low-value care and overtreatment, as well as avoiding preventable medicine-related harm.
“At the patient level, benefits of deprescribing may include improved adherence, reduced medicine-related costs and burden, and resolution of adverse drug reactions,” Ms Warriach said.
“However, implementation of deprescribing in practice remains limited due to various patient, prescriber and organisation-level barriers. Specifically, limitations in healthcare professionals’ knowledge of when and how to safely and effectively deprescribe.”
Senior author and Chair of the Australian Deprescribing Network (ADeN), Dr Emily Reeve said the team are conducting ongoing research to help determine how they can best support the development of actionable and evidence-based deprescribing recommendations.
“While more comprehensive deprescribing recommendations may facilitate the implementation of deprescribing in practice, there remains a need for recommendations to be simple and digestible,” Dr Reeve said.
“Guideline language, for example, is integral - recommendations should be uncomplicated, clear and persuasive. Although clinician expertise and discretion can be used to bridge the gap between recommendations and practice, in the absence of clear deprescribing recommendations, there is concern that recommendations will be misapplied, leading to unintended harm.”
This CMUS study contributes to ongoing efforts in Australia and internationally to enhance patient care by supporting healthcare professionals and patients to engage in deprescribing.
The complete findings of the study, titled "What Do Clinical Practice Guidelines Say About Deprescribing?” are available in BMJ Quality & Safety, and can be accessed online by clicking here.
https://doi.org/10.1136/bmjqs-2024-017101
Contact details:
Kate Carthew
0447 822 659
kate.carthew@monash.edu
