Reducing potentially inappropriate polypharmacy at a national and international level: the impact of deprescribing networks

Figures & data

Table 1. Examples of deprescribing networks with sample activities, publications and resources.

Network	Funding	Sample Activities	Sample Publications from Members	Sample Resources
ADeN	Non-funded/volunteer efforts	Website: https://www.australiandeprescribingnetwork.com.au/ Journal club Annual meeting Review and support grant applications Development of Recommendations for a National Strategic Action Plan to Reduce Inappropriate Polypharmacy [29]	Reducing inappropriate polypharmacy: the process of deprescribing [30]. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice [20] Patient barriers to and enablers of deprescribing: a systematic review [31] Impact of the Goal-directed Medication Review Electronic Decision Support System (G-MEDSS) on Drug Burden Index: A cluster-randomized clinical trial in primary care [32] Deprescribing to optimize health outcomes for frail older people: a double-blind placebo-controlled randomized controlled trial – outcomes of the Opti-med study [33]	The revised patients’ attitudes toward deprescribing questionnaire [34] Goal-directed Medication Review Electronic Support System (G-MEDSS): https://gmedss.com/landing Deprescribing tools for clinicians and consumers [35] Polypharmacy indicators [36] Clinical Practice Guidelines for deprescribing opioids [37], cholinesterase inhibitors and memantine [38]
CADeN	Health Canada The Canadian Institutes for Health Research Accelerating Clinical Trials Consortium	Website: https://www.deprescribingnetwork.ca/ Journal club (international) Annual report Public presentations Research community of practice	Factors influencing the effects of policies and interventions to promote the appropriate use of medicines in high-income countries: A rapid realist review [39] Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline [23] The MedSafer study – electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial [40]	EMPOWER Brochures [41] A framework for integrating deprescribing into healthcare curricula [42] Deprescribing guidelines: https://deprescribing.org/ Resources to get a better night’s sleep and deprescribe sleeping pills: https://mysleepwell.ca/ Deprescribing decision support: https://public.medsafer.org/public/start Translated deprescribing resources/patient handouts [43] (e.g. Arabic, simplified Chinese, Hindi, Korean, Punjabi, Tagalog, Urdu)
USDeN	United States National Institutes of Health	Website: https://deprescribingresearch.org/ Virtual work-in-progress seminars Annual meeting Webinars Stakeholder Engagement Annual Report Investigator development	Overcoming Inertia to Improve Medication Use and Deprescribing [44] Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge [45] Recommendations for outcome measurement for deprescribing intervention studies [46]	Grant opportunities Junior investigator intensive program Website resources for deprescribing study design
NERD	Non-funded volunteer efforts	Website: https://deprescribing.eu/ Webinars First international conference on deprescribing (ICOD 2022)	Health care professionals’ attitudes toward deprescribing in older patients with limited life expectancy: a systematic review [47] The role of behavioral science in changing deprescribing practice [48] Special issue in Basic and Clinical Pharmacology and Toxicology Journal: Advancing Deprescribing [49] Measuring quality of life in deprescribing [50]	Hospital deprescribing implementation framework

Abbreviations: ADeN – Australian Deprescribing Network; CADeN – Canadian Medication Appropriateness and Deprescribing Network; USDeN – United States Deprescribing Research Network; NERD – the Network of European Researchers in Deprescribing.

Quality Use of Medicines to Optimise Ageing in Older Australians: Recommendationsfor a National Strategic Action Plan to Reduce Inappropriate Polypharmacy. NHMRCCognitive Decline Partnership Centre, University of Sydney, in Collaboration with the AustralianDeprescribing Network and NPS MedicineWise. Sydney, NSW, Australia. 2018.

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Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. [2015 May 1];175(5):827. doi: 10.1001/jamainternmed.2015.0324

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Reeve E, Gnjidic D, Long J, et al. A systematic review of the emerging definition of “deprescribing” with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015 Dec;80(6):1254–1268. doi: 10.1111/bcp.12732

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Reeve E, To J, Hendrix I, et al. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. [2013 Oct 1];30(10):793–807. doi: 10.1007/s40266-013-0106-8

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Kouladjian O’Donnell L, Reeve E, Cumming A, et al. Development and dissemination of the national strategic action plan for reducing inappropriate polypharmacy in older Australians. Int Med J. 2021 Jan;51(1):111–115. doi: 10.1111/imj.15155

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Etherton-Beer C, Page A, Naganathan V, et al. Deprescribing to optimise health outcomes for frail older people: a double-blind placebo-controlled randomised controlled trial-outcomes of the Opti-med study. Age Ageing. [2023 May 1];52(5):afad081. doi: 10.1093/ageing/afad081

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Reeve E, Low LF, Shakib S, et al. Development and validation of the revised patients’ attitudes towards deprescribing (rPATD) questionnaire: versions for older adults and caregivers. Drugs Aging. [2016 Dec 1];33(12):913–928. doi: 10.1007/s40266-016-0410-1

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Deprescribing tools – NSW Therapeutic Advisory Group. NSW therapeutic advisory group – the new south wales therapeutic advisory group Inc. (NSW TAG) is an independent, not-for-profit member-based organisation, comprised of clinical pharmacologists, pharmacists, nurses and clinicians committed to promoting quality use of medicines (QUM) in NSW public hospitals and the wider community. 2021 [cited 2024 May 2. Available from: https://www.nswtag.org.au/deprescribing-tools/

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Polypharmacy QUM Indicators and Resources – NSW Therapeutic Advisory Group. NSW therapeutic advisory group – the new south wales therapeutic advisory group Inc. (NSW TAG) is an independent, not-for-profit member-based organisation, comprised of clinical pharmacologists, pharmacists, nurses and clinicians committed to promoting quality use of medicines (QUM) in NSW public hospitals and the wider community. 2022 [cited 2024 May 2. Available from: https://www.nswtag.org.au/polypharmacy-qum-indicators-and-resources/

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Langford AV, Lin CC, Bero L, et al. Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations. Med J Aust. [2023 Jul 17];219(2):80–89. doi: 10.5694/mja2.52002

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Reeve E, Farrell B, Thompson W, et al. Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary. Med J Aust. 2019 Mar;210(4):174–179. doi: 10.5694/mja2.50015

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Charbonneau M, Morgan SG, Gagnon C, et al. Factors influencing the effects of policies and interventions to promote the appropriate use of medicines in high-income countries: A rapid realist review. Health Policy. [2024 Feb 24];142:105027. doi: 10.1016/j.healthpol.2024.105027

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Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Can Fam Physician Med Fam Can. 2018 May;64(5):339–351.

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McDonald EG, Wu PE, Rashidi B, et al. The MedSafer study – electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial. JAMA Intern Med. [2022 Mar 1];182(3):265. doi: 10.1001/jamainternmed.2021.7429

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Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014 Jun;174(6):890–898. doi: 10.1001/jamainternmed.2014.949

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Farrell B, Raman-Wilms L, Sadowski CA, et al. A proposed curricular framework for an interprofessional approach to deprescribing. Med Sci Educ. [2023 Apr 1];33(2):551–567. doi: 10.1007/s40670-022-01704-9

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Canadian Medication Appropriatness and Deprescribing Network. Do I still need this medication? Is deprescribing for you? [Internet]. [Translated resources. Available from cited 2024 Feb 29]. Available from https://www.deprescribingnetwork.ca/translated-resources.

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Steinman MA, Landefeld CS. Overcoming inertia to improve medication use and deprescribing: patients, pharmacists, and physicians. JAMA. [2018 Nov 13];320(18):1867–1869. doi: 10.1001/jama.2018.16473

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Anderson K, Stowasser D, Freeman C, et al. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. [2014 Dec 1];4(12):e006544. doi: 10.1136/bmjopen-2014-006544

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Bayliss EA, Albers K, Gleason K, et al. Recommendations for outcome measurement for deprescribing intervention studies. J Am Geriatr Soc. 2022 Sep;70(9):2487–2497. doi: 10.1111/jgs.17894

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Lundby C, Graabaek T, Ryg J, et al. Health care professionals’ attitudes towards deprescribing in older patients with limited life expectancy: A systematic review. Br J Clin Pharmacol. 2019 May;85(5):868–892. doi: 10.1111/bcp.13861

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Scott S, Wright DJ, Bhattacharya D. The role of behavioural science in changing deprescribing practice. Br J Clin Pharmacol. 2021;87(1):39–41. doi: 10.1111/bcp.14595

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Lundby C, Thompson W. Advancing deprescribing: Learnings from the first international conference on deprescribing. Basic Clin Pharmacol Toxicol. 2024;134(1):3–5. doi: 10.1111/bcpt.13963

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Thompson W, Lundby C, Bleik A, et al. Measuring quality of life in deprescribing trials: a scoping review. Drugs Aging. [2024 Mar 20]. doi: 10.1007/s40266-024-01113-0

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