Identifying what we know about the efficacy of patient empowerment approaches towards deprescribing potentially inappropriate medicine use in older people - a systematic review

Older people are at the greatest risk of harm from medicines, resulting in adverse events such as falls and fractures, delirium and frailty. One approach to reducing medicine harms is to target the older patient as an agent of change within deprescribing interventions, often delivered through patient empowerment-based deprescribing approaches. This PROSPERO registered systematic review aimed to evaluate the effectiveness of these interventions upon two primary outcomes, the initiation of a deprescribing conversation and a change in Potentially Inappropriate Medicines (PIMs), and how efficacy relates to the behaviour change components of these interventions. Comprehensive searches across several electronic databases identified 21 eligible studies following double blinded screening of 2526 studies. There was limited evidence for interventions having a positive impact on deprescribing conversations, but better evidence of reduction in PIMs. Data and study design issues prevented meta-analysis. Two step factor analysis suggests self-efficacy, changing medicine beliefs and modelling (observing and imitating others), used in combination, have a greater likelihood of achieving PIMs reduction as part of a patient targeted deprescribing intervention. Patient-targeted deprescribing interventions are a promising adjunct to other deprescribing interventions.