Results 21 studies were included; most explored primary care physicians’ perspectives on managing older, community-based adults.
Prescribing of PIMs is independently associated with adverse drug events, hospital presentations, poorer health-related quality of life and death.11 12 Up to 15% of all hospitalisations involving older people in Australia are medication-related, with one in five potentially preventable.13 These well-documented harms of prescribing PIMs should evoke a response from clinicians to identify and stop, or reduce the dose of, inappropriate medications as a matter of priority.
While there is some evidence that PIM exposure has decreased marginally over recent years, its prevalence remains high.3 14–16 The process of reducing or discontinuing medications, with the goal of minimising inappropriate use and preventing adverse patient outcomes, is increasingly referred to as ‘deprescribing’.17 Although the term may be new, appropriate cessation or reduction of medication is a long accepted component of competent prescribing.18 19 The act of stopping a medication prescribed over months to years, however, is complicated by many factors related to patients and prescribers.
Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed.
Study characteristics were examined to explain differences in findings.
Reference lists and related citations of relevant articles were reviewed for additional studies.
The full search strategy is detailed in the online supplementary appendix.
Design A qualitative systematic review was undertaken by searching Pub Med, EMBASE, Scopus, Psyc INFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations.
A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias.
Filters to identify qualitative research were used and adapted to improve search sensitivity.24 These were combined with terms and text words for: medical and non-medical prescribers and either inappropriate prescribing or reducing, stopping or optimising medications.