Corresponding author:
Michael Steinman, MD
4150 Clement St Box 181G
San Francisco CA 94121
mike.steinman@ucsf.edu
Fax 415.750.6641
Tel 415.221.4810 x23677
There is much to celebrate about deprescribing research. The past decade
has seen an explosion of interest in the topic.1Recent scholarship has revealed key barriers and facilitators to
deprescribing, elucidated effective communication strategies, and
developed new measures. Moreover, it has demonstrated the potential for
deprescribing to improve outcomes, with meta-analyses finding that
intensive deprescribing interventions may reduce mortality and falls in
nursing homes by approximately 25%, and that comprehensive medical
review may yield similar reductions in mortality among older adults in
ambulatory settings.2,3
Yet, challenges abound. Many interventions which seemed promising have
had disappointing results, and we have gained appreciation of how
difficult deprescribing can be. In clinical practice, many people are
reluctant to stop medications they were previously told they needed, and
clinicians often lack incentive, willingness, or adequate time to make
proactive efforts to deprescribe. Even when successful, real-world
translation of interventions remains limited, and the push for
aggressive medication therapy remains deeply embedded in health systems.
Reducing medication count, a common outcome of studies, is not
necessarily a win for patients if the discontinued medications were not
bothersome or costly to them or their caregivers.
Deprescribing research is thus at a crossroads. While we celebrate
initial successes, the easiest work is behind us. As we look ahead, I
offer 6 recommendations for how the field can continue to grow,
developed from my own reflections, conversations with leaders in the
field, and past literature4 and initially presented as
a talk at the first International Conference on Deprescribing in
September 2022.