Identification of Behaviour Change Techniques in Deprescribing Interventions: A Systematic Review and Meta-Analysis.

Hansen, C R; O'Mahony, D; Kearney, P M; Sahm, L J; Cullinan, S; Huibers, C J A; Thevelin, S; Rutjes, A W S; Knol, W; Streit, Sven; Byrne, S (2018). Identification of Behaviour Change Techniques in Deprescribing Interventions: A Systematic Review and Meta-Analysis. British journal of clinical pharmacology, 84(12), pp. 2716-2728. Wiley-Blackwell 10.1111/bcp.13742

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AIMS

Deprescribing interventions safely and effectively optimise medication use in older people. However, questions remain about which componentsof interventions are key to effectively reduce inappropriate medication use. This systematic review examines the behaviour change techniques (BCTs) of deprescribing interventions and summarises intervention effectiveness on medication use and inappropriate prescribing.

METHODS

MEDLINE, EMBASE, Web of Science and Academic Search Complete and grey literature were searched for relevant literature. Randomised controlled trials (RCTs) were included if they reported on interventions in people aged ≥65 years. The BCT taxonomy was used to identify BCTs frequently observed in deprescribing interventions. Effectiveness of interventions on inappropriate medication use was summarised in meta-analyses. Medication appropriateness was assessed in according to STOPP criteria, Beers' criteria and national or local guidelines Between study heterogeneity was evaluated by I-squared and Chi-squared statistics. Risk of bias was assessed using the Cochrane Collaboration Tool for randomised controlled studies.

RESULTS

Of the 1561 records identified, 25 studies were included in the review. Deprescribing interventions were effective in reducing number of drugs and inappropriate prescribing, but a large heterogeneity in effects was observed. BCT clusters including goals and planning; social support; shaping knowledge; natural consequences; comparison of behaviour; comparison of outcomes; regulation; antecedents; and identity had a positive effect on the effectiveness of interventions.

CONCLUSIONS

In general, deprescribing interventions effectively reduce medication use and inappropriate prescribing in older people. Successful deprescribing is facilitated by the combination of BCTs involving a range of intervention components.

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