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

TY - JOUR

T1 - Identification of behaviour change techniques in deprescribing interventions

T2 - a systematic review and meta-analysis

AU - Hansen, Christina R.

AU - O'Mahony, Denis

AU - Kearney, Patricia M.

AU - Sahm, Laura J.

AU - Cullinan, Shane

AU - Huibers, C. J.A.

AU - Thevelin, Stefanie

AU - Rutjes, Anne W.S.

AU - Knol, Wilma

AU - Streit, Sven

AU - Byrne, Stephen

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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.

AB - 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.

KW - behaviour change techniques

KW - deprescribing

KW - meta-analysis

KW - systematic review

UR - http://www.scopus.com/inward/record.url?scp=85053711883&partnerID=8YFLogxK

U2 - 10.1111/bcp.13742

DO - 10.1111/bcp.13742

M3 - Review

C2 - 30129139

AN - SCOPUS:85053711883

SN - 0306-5251

VL - 84

SP - 2716

EP - 2728

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

IS - 12

ER -