A systematic review of the emerging definition of 'deprescribing' with network analysis: implications for future research and clinical practice

Abstract

Aims: The aim of this study was to identify what definitions have been published for the term 'deprescribing', and determine whether a unifying definition could be reached. A secondary aim was to uncover patterns between the published definitions which could explain any variation.

Methods: Systematic literature searches were performed (earliest records to February 2014) in MEDLINE, Embase, CINAHL, Informit, Scopus and Google Scholar. The terms deprescrib* or de-prescrib* were employed as a keyword search in all fields. Conventional content analysis and word frequencies were used to identify characteristics of the definitions. Network analysis was conducted to visualize characteristic distribution across authors and articles.

Results: Following removal of duplicates, 231 articles were retrieved, 37 of which included a definition. Eight characteristics of the definitions were identified: use of the term stop/withdraw/cease/discontinue (35 articles), aspect of prescribing included e.g. long term therapy/inappropriate medications (n = 18), use of the term 'process' or 'structured' (n = 13), withdrawal is planned/supervised/judicious (n = 11), involving multiple steps (n = 7), includes dose reduction/substitution (n = 7), desired goals/outcomes described (n = 5) and involves tapering (n = 4). Network analysis did not reveal patterns responsible for variations in previously used definitions.

Conclusions: These findings show that there is lack of consensus on the definition of deprescribing. This article proposes the following definition: 'Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes'. This definition has not yet been externally validated and further work is required to develop an internationally accepted and appropriate definition.

Figure 1

PRISMA flow chart of included articles in the systematic review of the definition of deprescribing

Figure 2

Word cloud of definition of deprescribing (words which occurred two or more times, stemmed words grouped, minimum four characters)

Figure 3

Network analysis of the definition of deprescribing. A) author network, Nodes are sized by number of included articles authored. B) article network, Nodes are sized by indegree of citation ties. Colours of nodes represent definition characteristics: grey node = characteristic not present, coloured node = characterirstic present.