# An Internationally Derived Process of Healthcare Professionals’ Proactive Deprescribing Steps and Constituent Activities

## TL;DR

This paper outlines a validated process for healthcare professionals to safely stop unnecessary medications before harm occurs, involving four steps and 17 activities.

## Contribution

The paper introduces a globally validated framework for proactive deprescribing, including constituent activities and insights into barriers and enablers.

## Key findings

- A four-step proactive deprescribing process was developed and validated with healthcare professionals from 25 countries.
- All 17 activities in the framework were considered important by at least 70% of respondents.
- Nine activities require direct patient or caregiver collaboration, but seven are only sometimes performed.

## Abstract

Proactive deprescribing is the process of tapering or stopping a medicine before harm occurs. This study aimed to specify and validate, with an international sample of healthcare professionals, a proactive deprescribing process of steps and constituent activities. We developed a proactive deprescribing process framework of steps which we populated with literature-derived activities required to be undertaken by healthcare professionals. We distributed a survey to healthcare professionals internationally, requesting for each activity the frequency of its occurrence in practice and whether it was important. Extended response questions investigated barriers and enablers to deprescribing. The 263 survey respondents were from 25 countries. A proactive deprescribing process was developed comprising four steps: (1) identify a patient for potential stop of a medicine, (2) evaluate a patient for potential stop of a medicine, (3) stop a medicine(s), and (4) monitor after a medicine has been stopped, and 17 activities. All activities were considered important by ≥70% of respondents. Nine activities required healthcare professionals to undertake in direct partnership with the patient and/or caregiver, of which seven were only sometimes undertaken. Deprescribing interventions should include a focus on addressing the barriers and enablers of healthcare professionals undertaking the activities that require direct partnership with the patient and/or caregiver.