Hui Wen Quek, Xisco Reus, Kenneth Lee, Veronika Seda, Leon Adams, Osvaldo P Almeida, Gillian E Caughey, Jennifer Gowan, Kerryn Hart, Andrew Heredia, Anne-Marie Hill, Lisa Kalisch Ellett, Dina LoGiudice, Arduino A Mangoni, Anthony Marinucci, Treasure McGuire, Nilufeur McKay, Vasi Naganathan, Christopher Ng, Maz Osborne, Kevan R Polkinghorne, Constance D Pond, Sepehr Shakib, Angela Shiu, Andrew Stafford, Tim Whitmore, Christopher Etherton-Beer, Amy Page
Healthcare professionals considered the content, language, and format of deprescribing recommendations to be intrinsic to implementability. Deprescribing-specific factors, particularly the operational complexity of how to deprescribe and risk-framing considerations, extended beyond GLAFI's principles. These findings highlight opportunities to improve future deprescribing recommendations and to strengthen implementability frameworks for de-implementation.
INTRODUCTION: Deprescribing is the planned withdrawal or dose reduction of medicines when harms outweigh benefits or when they are no longer required. Following publication of the Clinical Practice Guideline for Deprescribing in Older People in September 2025, supporting its uptake into routine practice is a critical next step.
AIM: This study aimed to identify implementation strategies, informed by stakeholder-perceived barriers, to support the implementation of deprescribing guidelines.
METHOD: A qualitative analysis was undertaken of open-text responses collected during the guideline public consultation (24 April-31 May 2025). Inductive thematic analysis identified implementation barriers, which were then deductively mapped to the Consolidated Framework for Implementation Research (CFIR). Relevant CFIR constructs were entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool to generate implementation strategies. Strategies were ranked by cumulative percentage endorsement and grouped using ERIC concept-mapping clusters.
RESULTS: Of 313 survey respondents, 248 provided responses relevant to implementation. Three barrier themes were shared across consumer and professional/policy stakeholder groups. Theme 1: 'Knowledge gaps, beliefs, and limited readiness to deprescribe' describes gaps in consumers' and clinicians' knowledge, beliefs about medication use and deprescribing, and limited confidence or willingness to engage in deprescribing. Theme 2: 'Communication, hierarchy, or social influences limiting deprescribing' describes communication gaps, entrenched prescribing norms, power imbalances, and social influences that limited shared decision-making. Theme 3: 'System-level structures misaligned with deprescribing practice' describes broader healthcare system barriers, including financial, policy, workforce, organisational, and information-related constraints. Consumers additionally highlighted a lack of person-centred and adaptable approach for deprescribing, while professional/policy stakeholders identified barriers related to medicine formulations and guideline format and usability. Barriers mapped predominantly to the CFIR Inner Setting domain. The highest-ranked implementation strategy was 'Identify and prepare champions', within the 'Develop stakeholder interrelationships' cluster.
CONCLUSION: Deprescribing barriers were largely situated within the Inner Setting domains. Recommended strategies emphasised stakeholder engagement and local champions, supporting locally led, relationship-based implementation approaches. Future work should evaluate the feasibility, acceptability, and effectiveness of these strategies in practice.