Ten deprescribing articles you should know about: a guide for newcomers to the field

Deprescribing is the planned and supervised process of stopping a medication when that medication may no longer be necessary, is causing more harm than good, or does not align with a person’s healthcare goals and treatment preferences. There has been an explosion of deprescribing research published over the last 10 years. Researchers in the field have been doing everything from evaluating deprescribing rates in usual care to studying barriers and facilitators around establishing deprescribing in routine clinical practice. More recently, interventions specifically designed to intervene on major determinants have been developed and tested. For someone new to the field (e.g., researchers new to the field, trainees, or clinicians interested in learning more about deprescribing research), it might be difficult to know where to begin in order to gain a solid grasp of the deprescribing literature.

At the 1^st International Conference on Deprescribing, held in Denmark in September 2022, this author group discussed which deprescribing articles represented work that collectively provides a diverse overview of the field for newcomers. We hoped such a collection of articles would provide an overview of the breadth of work in this area and highlight seminal pieces which shaped the field. We were inspired by the success of similar lists in related fields¹ and previous discussions on social media.

Our group of deprescribing experts (n=8) first generated a preliminary list of 31 possible articles, from which we aimed to narrow down to a final 10. We tasked ourselves with thinking about articles that covered a broad range of topics in the field, and articles that had the following characteristics: high impact on the field, high-level articles (such as reviews, which could provide broad overview of research on a specific topic), or studies which incorporated novel approaches. Once we generated a preliminary list, we sent out a survey asking the eight authors ““Should this article be in the Top 10?” for the 31 candidate articles. We tallied the “Yes” votes, and the ten articles with the most “Yes” votes were included in the final list. We created the following categories to group the articles under after the Top 10 were identified: “Critical concepts”, “High level overviews”, “Major trials”, “The complexity of deprescribing” and “Knowledge synthesis in deprescribing”.

There are some articles which did not make the Top 10 that some of us still felt strongly were useful for newcomers to know about. These articles offer additional insight into important concepts in the field such as design of deprescribing interventions², countering cognitive biases related to deprescribing,³ and the consequences of polypharmacy.⁴ Newcomers may also want to be aware of landmark trials that have tested novel deprescribing concepts or interventions,^5–7 as well as the recent focus on implementation science in the field of deprescribing,⁸ and the influence of health system factors on deprescribing implementation and success.⁹

We recognise that this list is not exhaustive by any means and is based on the opinions of a group of established researchers in the field. It is not a comprehensive list of all the important deprescribing articles. However, it provides a start-up kit for newcomers wondering “where to start?”.

Table 1.

Ten deprescribing articles for newcomers to the field.

First author, year	Title	Comments
Critical concepts
Holmes 200610	Reconsidering medication appropriateness for patients in late life	Introduction to key aspects that inform deprescribing such as time to benefit, life expectancy, goals of care, balance of benefits and harms of medications
Boyd 200411	Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance	An examination of the implications of treatment guidelines for single diseases on older adults with multiple health problems
High level overviews
Scott 201512	Reducing inappropriate polypharmacy: the process of deprescribing	A framework for the process of deprescribing, highlighting key steps and considerations
Reeve 201713	Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action	Narrative review covering ‘what is deprescribing’, the potential benefits and harms, and barriers, enablers and opportunities for taking action (with references for further reading)
Major trials
Tannenbaum 201414	Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial	Trial of educating patients using a deprescribing patient empowerment intervention delivered through community pharmacies
Sheppard 202015	Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial	Contemporary trial incorporating a novel approach in the field (noninferiority) to examine the effects of deprescribing
The complexity of deprescribing
Doherty 202016	Barriers and facilitators to deprescribing in primary care: a systematic review	A comprehensive review highlighting the challenges of deprescribing in routine care
Weir 202217	Consumer attitudes towards deprescribing: a systematic review and meta-analysis	A summary of papers which have examined how consumers across the world feel about deprescribing
Knowledge synthesis in deprescribing
Gnjidic 202218	Achieving sustainable healthcare through deprescribing	Introduction to and synthesis of a collection of Cochrane Reviews related to deprescribing that discusses the challenges of evidence synthesis in this field
Farrell 201619	Methodology for developing deprescribing guidelines: using evidence and GRADE to guide recommendations for deprescribing	A framework for synthesizing deprescribing evidence into clinical practice guidelines for clinicians and patients, see deprescribing.org for related work