Pharmacists' barriers and enablers to deprescribing: A systematic review and meta-synthesis.

BACKGROUND

Deprescribing is beneficial in reducing medication burden and improving patient outcomes. Deprescribing success is influenced by both patient and health care professional barriers and enablers. Pharmacists can play an important role in deprescribing success, yet little is known about this profession's specific barriers and enablers to deprescribing.

OBJECTIVES

The primary objective of this study was to summarize the literature on pharmacists' barriers and enablers to deprescribing across multiple healthcare settings.

METHODS

A systematic review of the available literature was completed. MEDLINE, EMBASE, and CINAHL databases were searched from inception to December 5, 2025. Studies were included if they explored pharmacist perspectives on barriers and enablers to deprescribing of medications using qualitative or quantitative methodologies. Inductive thematic synthesis was used to identify barriers and enablers from qualitative studies. Barriers and enablers were mapped to the Capability, Opportunity, Motivation behavioural framework. The quality of included studies was assessed with the Critical Appraisal Skills Programme tools for qualitative and quantitative studies.

RESULTS

A total of 47 studies were included in this review. Studies utilized qualitative (n = 32), quantitative (n = 9) and mixed (n = 6) methodologies. There was a total of 2762 pharmacist participants working in a variety of healthcare settings, including hospital, community, long-term care and speciality or consultant practices. The meta-synthesis of qualitative studies identified 5 enablers and 9 barriers. Opportunistic barriers included lack of interprofessional collaboration, prescriber and patient/caregiver unwillingness, absence of deprescribing algorithms, and insufficient clinical information. Motivational barriers included pharmacist scope of practice, stable clinical conditions, competing priorities, and a lack of financial incentives. Opportunistic enablers include patient interest, interprofessional collaboration, and deprescribing resources. Motivational enablers included professional responsibility and deprescribing to address drug therapy problems.

DISCUSSION: There was a variety of practice settings and deprescribing focuses (i.e., potentially inappropriate medications, benzodiazepines, opioids) in the included studies. These differences may limit the applicability of findings to specific practice sites or medication classes. Nevertheless, the findings of this study highlight that structural changes such as advancing pharmacist scope of practice, redesigning renumeration models, integrating healthcare systems and improving the data sharing are required to optimize pharmacist's role in deprescribing.