Intended for healthcare professionals

Letters Deprescribing in older people

Poor uptake of interdisciplinary medicine reviews for older people is a barrier to deprescribing

BMJ 2016; 353 doi: (Published 28 June 2016) Cite this as: BMJ 2016;353:i3496
  1. Rohan A Elliott, clinical senior lecturer and senior aged care pharmacist1 2,
  2. Cik Yin Lee, research fellow1 3
  1. 1Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
  2. 2Pharmacy Department, Austin Health, Melbourne, Victoria, Australia
  3. 3Royal District Nursing Service (RDNS) Institute, Melbourne, Victoria, Australia
  1. rohan.elliott{at}

In their recent article about deprescribing through shared decision making,1 Jansen and colleagues note that many of the triggers for deprescribing can be identified only by a medicine review and that this review can be triggered by important “life transitions.” These include hospital admission, residential care admission, referral to an aged care assessment service (ACAS) due to functional decline, or referral to a community nursing service for medicines management support.

But does evidence show that these transitions currently lead to a medicine review? In Australia publicly funded interdisciplinary medicine reviews, known as home medicines reviews (HMRs), have been available for 15 years.2 However, studies of HMR uptake have found that only 5-10% of older people discharged from hospital, who are referred to an ACAS or community nursing service or who reside in supported accommodation, receive an HMR.3

Many barriers to HMRs have been identified, but most have not been resolved. New approaches to improve access to interdisciplinary medicine reviews within primary care are needed to help deprescribing. These include simplification and improved targeting of the HMR model, along with implementation of new collaborative care models integrating pharmacists into general practice clinics, ACAS teams, and community nursing services.2 4 5


  • Competing interests: None declared.


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