Pharmacists Need Greater Support for Deprescribing Services

In an attempt to implement deprescribing services into a community pharmacy practice, pharmacists claimed they did not receive enough guidance to successfully deprescribe and address all barriers impeding implementation, according to a study published in Exploratory Research in Clinical and Social Pharmacy.¹

Pharmacist participants within the study said they would need more experience and feedback to confidently make clinical decisions under uncertainty, highlighting the need to enhance the pharmacist’s role in deprescribing through a variety of approaches.

“Despite its potential, deprescribing is not yet routine practice. Barriers include limited training and communication skills among professionals, poor interprofessional coordination, and insufficient evidence or practical guidance to support decision-making,” wrote the authors of the study.¹ “Studies indicate that the existence of a guideline itself may serve as a motivational factor for deprescribing and that the presence of such guidelines can enhance the self-efficacy of providers.”

Although guidelines provide a necessary foundation, the focus group study emphasized that drug-specific fact sheets alone cannot resolve the complex reality of clinical decision-making. Participants noted that they often feel caught in the middle when attempting to modify medications initiated by specialists, as general practitioners may hesitate to intervene due to unclear boundaries of professional responsibility.

READ MORE: The Vital Role of Pharmacists in Polypharmacy Management

This systemic fragmentation is a major driver of what researchers call medication overload, a phenomenon where the harms of a drug regimen clearly outweigh the benefits. The stakes are high, as excessive polypharmacy—often defined as the use of 5, 10, or more medications—is linked to a higher risk of adverse drug reactions, decreased mobility, and increased hospitalizations.^2-4

The historical trajectory of this practice shows that although the term “deprescribing” was coined in 2003, it has only recently moved from a theoretical concept to a clinical necessity. Pharmacists are now facing a “prescribing cascade,” where one medication’s adverse effects are treated with another drug, leading to a cycle of over-medication that can compromise patient safety.⁵

“Working in a community setting and then personally experiencing it with loved ones, I felt that we don’t have enough advocates in the deprescribing space,” DeLon Canterbury, PharmD, BCGP, CEO of GeriatRx, told Drug Topics. “I don’t mean just in a clinical setting; we don’t have enough dialogue among caregivers and loved ones and family members to really figure it out.”

A scoping review of pharmacist interventions suggests that while their role has evolved from simple dispensing to assessing medication appropriateness and conducting reconciliations, these clinical services are not yet a standard part of the community pharmacy workflow, as stated by a study published in the International Journal of Clinical Pharmacy.⁴

One of the most significant hurdles identified by community pharmacists is the lack of a feedback loop. Unlike initiating a therapy where the clinical effect is often measurable, such as a drop in blood pressure, the outcomes of stopping a medication are harder to monitor.¹

Pharmacists expressed a desire for integrated clinical decision-support tools that would allow them to track the long-term impact of their recommendations. Without this data, building the necessary interprofessional trust with physicians remains difficult, even though collaborative trust is cited as a primary enabler for successful deprescribing.

Furthermore, the current economic landscape of pharmacy practice remains a barrier to scaling these services. In many regions, reimbursement models are still tied to the volume of medications dispensed rather than the time-intensive process of clinical consultation and tapering.¹

Research indicates that for deprescribing to become sustainable, health policies must shift to recognize the financial and clinical value of reducing unnecessary drug use.^2,4

Despite these challenges, there are practical facilitators that can be leveraged today. The focus group participants noted that patients using multidose drug dispensing systems are often ideal candidates for deprescribing, as these systems simplify the tapering process and prevent the stockpiling of discontinued medication.¹

Additionally, although patients may be apprehensive about stopping long-term medications, evidence suggests that the vast majority are willing to have a conversation about deprescribing when it is led by a trusted provider.²

Supporting pharmacists in this role requires more than just better guidelines but a structural shift that includes specialized training, improved access to patient records, and a reimbursement system that prioritizes patient outcomes over pill counts.^1,2,4

“Optimization requires additional practical training and decision support for community pharmacists, as well as stronger collaboration with general practitioners, increased general practitioner awareness, clear task allocation, and regular feedback on outcomes,” concluded the authors of the current study.¹ “Finally, adequate organizational support and reimbursement are essential to embed the use of the guideline and fact sheets sustainably in clinical practice.”

READ MORE: HHS Designs Action Plan to Address Overprescribing of SSRIs

REFERENCES

1. Bakker S, Baas G, Bouvy ML, et al. Implementation of a deprescribing guideline by community pharmacists: a focus group study. Explor Res Clin Soc Pharm. 2026;23:100813. https://doi.org/10.1016/j.rcsop.2026.100813

2. Thompson W, McDonald EG. Polypharmacy and deprescribing in older adults. Annual Review of Medicine. September 20, 2023:113-127. https://doi.org/10.1146/annurev-med-070822101947

3. Vordenberg SE, Malani PN, Kullgren JT. Polypharmacy and deprescribing. JAMA. 2023;330(7):672. doi:10.1001/jama.2023.8872

4. Ouraou R, Cossette B, Perron ME, et al. Pharmacists' role in interventions addressing excessive polypharmacy: a scoping review. Int J Clin Pharm. 2026 Feb;48(1):17-26. doi: 10.1007/s11096-025-01971-7.

5. Thomas L. The history of deprescribing. News-Medical. July 13, 2022. Accessed June 15, 2026. https://www.news-medical.net/health/The-History-of-Deprescribing.aspx