Identification of behaviour change techniques in deprescribing interventions: a systematic review and meta-analysis

Abstract

Aims: Deprescribing interventions safely and effectively optimize medication use in older people. However, questions remain about which components of interventions are key to effectively reduce inappropriate medication use. This systematic review examines the behaviour change techniques (BCTs) of deprescribing interventions and summarizes 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. Randomized 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 summarized in meta-analyses. Medication appropriateness was assessed in accordance with 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 randomized 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.

Keywords: behaviour change techniques; deprescribing; meta-analysis; systematic review.

Figure 1

PRISMA flow chart of study selection

Figure 2

Results of risk of bias assessment

Figure 3

Frequency of behaviour change techniques (BCTs) coded for studies reporting intervention effectiveness on the key outcomes of this review compared to studies reporting no effectiveness of interventions. The frequencies are weighed values based on the number of studies in each group, i.e. effectiveness versus no effectiveness

Figure 4

Mean difference in the change in number of drugs comparing experimental (intervention) group and control group. Subgroup analysis on intervention setting (outpatient setting versus hospital setting)

Figure 5

Number of participants with inappropriate drugs comparing experimental (intervention) group and control group. Subgroup analysis on risk of bias assessment (allocation concealment)