The role of behavioural science in changing deprescribing practice

Over 50% of older people are prescribed a medicine with more harm than benefit leading to avoidable morbidity, hospitalisation and mortality.1 The World Health Organisation has recognised this problem in its recent Global Patient Safety Challenge: Medication Without Harm. Deprescribing is the process of identifying and discontinuing medicines that are no longer appropriate. The term deprescribing is a relative newcomer to the research and clinical vocabulary. Medicines may be deprescribed for several reasons including when they are no longer indicated, when the harms outweigh the benefits or when treatment may not align with the patient's health care goals and treatment preferences. Whilst the principle of deprescribing has always been an expectation of good prescribing practice, there are numerous barriers to it becoming routine that are discussed in Section 3.2, 3

Deprescribing involves establishing an accurate account of the patient's prescribed medicines, identifying medicines that are appropriate for deprescribing, achieving agreement with the patient to attempt deprescribing and ensuring monitoring and appropriate safety netting are in place. It therefore requires practitioner and patient behaviours to align as they collaboratively navigate the process. Despite global traction towards developing strategies to support practitioners and patients to deprescribe, there have been only marginal successes in effecting change in deprescribing behaviour.4

The three key unknowns to designing interventions to change behaviour are (1) defining the target behaviour, (2) specifying whose behaviour needs to change and (3) identifying how to achieve the desired change.3 The field of behavioural science applies theory and empirical evidence to address these three unknowns.