Less is more: Effective deprescribing in community settings: A systematic review and meta-analysis

Background

Potentially inappropriate medications (PIMs) and polypharmacy are common and associated with adverse health outcomes and increased healthcare costs. While deprescribing interventions have been widely studied in clinical and institutional settings, their effectiveness and economic impact in community settings remain insufficiently synthesized. This study aimed to evaluate the effectiveness of deprescribing interventions in reducing PIM use and improving economic outcomes.

Methods

A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines, searching Embase, CENTRAL, and MEDLINE up to April 2025. Studies evaluating deprescribing interventions in community-based settings were included, with the exclusion of non-original research, qualitative studies, and non-community settings. Data extraction followed a standardized protocol. Risk of bias was assessed using validated tools for randomized and non-randomized studies. Random-effects meta-analysis was performed for studies reporting comparable outcomes.

Results

Twenty-seven studies were included, of which nine contributed to the meta-analysis. Deprescribing interventions were associated with a statistically significant reduction in medication use, including PIMs (effect size −0.32, SE = 0.14, 95% CI: [-0.59; -0.05]), indicating a modest but consistent effect across studies. Reductions in inappropriate prescribing were observed across the majority of included studies in community-based settings. Eight studies reporting economic outcomes indicated consistent cost reductions or favorable cost-effectiveness profiles.

Conclusions

Deprescribing interventions in community-based settings are effective in reducing inappropriate medication use and may contribute to improved economic outcomes. These findings support the integration of deprescribing strategies into routine care. Further research is needed to assess long-term effects and implementation across diverse healthcare systems.

Key messages

• Deprescribing reduces potentially inappropriate medication use in community-based settings.

• Implementation of deprescribing may improve efficiency and reduce healthcare costs.