Deprescribing tendencies within primary health care : a literature review

Abstract

BACKGROUND: Polypharmacy increases in older persons and in multimorbid patients thus becoming prevalent in primary health care. While deprescribing offers a patient-centered, systematic approach to reducing potentially inappropriate medicines, implementation remains inconsistent based on clinical, systemic, and patient-level factors.

AIM: The purpose of this literature review is to outline the enablers and barriers of deprescribing in primary care and, on the basis of current evidence, identify successful solutions for implementation.

METHOD: A review of the literature was performed utilising PubMed, Medline, Cochrane Library and Embase, as institutional databases. English publications between 2020 and mid-2025 were screened utilising predefined inclusion and exclusion criteria. The Critical Appraisal Skills Programme (CASP) framework was used to critically appraise the peer-reviewed articles. Data were synthesised thematically with arising patterns grouped into their own main themes and sub-themes.

RESULTS: Dominant themes that occurred were prescriber confidence, patient refusal, time constraints, and lack of overt guidelines as key barriers. Enablers such as multidisciplinary collaboration, use of evidence-based deprescribing tools (e.g. STOPP/ START, Beers Criteria), and patient engagement were reported across all settings. Implementation strategies varied between settings but the majority contained important pharmacist interventions, education programmes, and formal implementation protocols.

CONCLUSION: Deprescribing within primary care can be done and is necessary but requires multi-faceted interventions targeting individual prescribers, systems, and patients. To enhance uptake and sustainment, deprescribing has to be incorporated into routine care in combination with training, decision aids, and policy-level promotion.