- Tips for conducting literature searches about deprescribing
The field of deprescribing has evolved over the past thirty years. Earlier studies focused on medication optimization and appropriate medication use where deprescribing may be an element of a complex intervention. In more recent years, studies have increasingly focused on deprescribing interventions that target a medication(s), medication class, or therapeutic class. Depending on the purpose of the literature search, it may be important to acknowledge the evidence and research from the early broader medication optimization studies.
Because of this evolution, no single MeSH term exists to capture the literature related to deprescribing, as relevant articles also include related studies such as optimizing medications, reducing polypharmacy etc.
Subject headings are useful but not sufficient to do a comprehensive search. In Medline, for example, the MeSH term “Deprescriptions” has only been used since 2016. It is necessary to take a broad approach to identify articles in this area by combining several concepts related to medication discontinuation, such as inappropriate prescribing and withdrawal of drugs.
The bottom of this page contains 2 sections, each of which is tailored to a different platform for conducting literature searches: EBSCO and PubMed. Each platform uses different search terminology to query the Medline database, which contains abstracts of articles published in the health sciences literature.
Section A includes two searches that can be run individually or combined (i.e., Search 1 OR Search 2) on the EBSCO platform. Search 1 does not include individual drug names or classes whereas Search 2 provides the option to include individual drug classes. Both searches include a section that restricts the results to articles about older people.
Section B includes searches that can be run on PubMed search strategy (Section B, Search 1); this is less comprehensive and less precise.
Note that searches that omit individual drug names may miss a large proportion of potentially relevant studies. Thus, in addition to the concepts above, consider adding individual drug names and classes of medications of interest. Prior experience has demonstrated substantial non-overlap of deprescribing searches that do and do not contain individual drug names.
Using this broad approach to conducting deprescribing literature searches will ensure that the search is comprehensive. However, it may result in a high yield of articles that are not relevant (prior experience with this strategy has yielded 5000+ articles).
It is helpful to develop clear study objective(s) and PICOTS: population, intervention, comparators (optional), outcomes, timing of follow-up and dates searched, study design/setting (optional). Having this information specified will allow you to further narrow your search so that you will not have as many titles and abstracts to review to identify the relevant studies.
Prepared by Shelly Gray, PharmD, MS, Beth Devine, PharmD, PhD and Diana Louden, MLib, University of Washington, School of Pharmacy (rev 11/21/21)
A. Search strategies for the Medline database on the EBSCO platform
These searches have not been formally validated.
Search 1 — This search is general and does not include any drug names or drug classes.
The general approach is Older People AND Deprescribing.
(MH “Aged+” OR MH “Health Services for the Aged” OR MH “Geriatric Assessment” OR MH “Geriatrics” OR MH “Geriatric Psychiatry” OR MH “Geriatric Nursing” OR MH “Geriatric Dentistry” OR MH “Dental Care for Aged” OR MH “Homes for the Aged” OR MH “Nursing Homes+” OR MH “Housing for the Elderly” OR TI (elder OR elders OR eldest OR elderly OR geriatric* OR “old age” OR “oldest old” OR “senior citizen” OR “senior citizens” OR “very old” OR septuagenarian* OR octogenarian* OR octagenarian* OR nonagenarian* OR centarian* OR centenarian* OR supercentenarian* OR “older people” OR “older person” OR “older subject” OR “older subjects” OR “older patient” OR “older patients” OR “older age” OR “older aged” OR “older ages” OR “older adult” OR “older adults” OR “older man” OR “older men” OR “older male” OR “older males” OR “older woman” OR “older women” OR “older female” OR “older females” OR “older veterans” OR “older population”) OR AB (elder OR elders OR eldest OR elderly OR geriatric* OR “old age” OR “oldest old” OR “senior citizen” OR “senior citizens” OR “very old” OR septuagenarian* OR octogenarian* OR octagenarian* OR nonagenarian* OR centarian* OR centenarian* OR supercentenarian* OR “older people” OR “older person” OR “older subject” OR “older subjects” OR “older patient” OR “older patients” OR “older age” OR “older aged” OR “older ages” OR “older adult” OR “older adults” OR “older man” OR “older men” OR “older male” OR “older males” OR “older woman” OR “older women” OR “older female” OR “older females” OR “older veterans” OR “older population”))
AND
(MH “Deprescriptions” OR MH “Inappropriate Prescribing” OR MM “Drug Utilization Review” OR TI (deprescri* OR “de prescribing” OR “de prescription” OR “inappropriate prescribing” OR “inappropriate prescription” OR “inappropriate prescriptions” OR “over prescribing” OR “inappropriate medications” OR “inappropriate medication”) OR AB (deprescri* OR “de prescribing” OR “de prescription” OR “inappropriate prescribing” OR “inappropriate prescription” OR “inappropriate prescriptions” OR “over prescribing” OR “inappropriate medications” OR “inappropriate medication”))
Note: To combine the results of Search 1 and Search 2, insert “OR” between them at this point – as in (Older People AND Deprescribing) OR (Older People AND Deprescribing)
Search 2 — This search can be tailored to include any specific drug names or drug classes.
The general approach is Older People AND Deprescribing. In this search, terms relating to deprescribing or withdrawing must be within 3 words of drug terms.
(MH “Aged+” OR MH “Health Services for the Aged” OR MH “Geriatric Assessment” OR MH “Geriatrics” OR MH “Geriatric Psychiatry” OR MH “Geriatric Nursing” OR MH “Geriatric Dentistry” OR MH “Dental Care for Aged” OR MH “Homes for the Aged” OR MH “Nursing Homes+” OR MH “Housing for the Elderly” OR TI (elder OR elders OR eldest OR elderly OR geriatric* OR “old age” OR “oldest old” OR “senior citizen” OR “senior citizens” OR “very old” OR septuagenarian* OR octogenarian* OR octagenarian* OR nonagenarian* OR centarian* OR centenarian* OR supercentenarian* OR “older people” OR “older person” OR “older subject” OR “older subjects” OR “older patient” OR “older patients” OR “older age” OR “older aged” OR “older ages” OR “older adult” OR “older adults” OR “older man” OR “older men” OR “older male” OR “older males” OR “older woman” OR “older women” OR “older female” OR “older females” OR “older veterans” OR “older population”) OR AB (elder OR elders OR eldest OR elderly OR geriatric* OR “old age” OR “oldest old” OR “senior citizen” OR “senior citizens” OR “very old” OR septuagenarian* OR octogenarian* OR octagenarian* OR nonagenarian* OR centarian* OR centenarian* OR supercentenarian* OR “older people” OR “older person” OR “older subject” OR “older subjects” OR “older patient” OR “older patients” OR “older age” OR “older aged” OR “older ages” OR “older adult” OR “older adults” OR “older man” OR “older men” OR “older male” OR “older males” OR “older woman” OR “older women” OR “older female” OR “older females” OR “older veterans” OR “older population”))
AND
(TI ((medication* OR medicin* OR prescription* OR prescrib* OR polypharmacy* OR pharmaceutical* OR drug OR drugs OR “individual drug name or class”) N3 (deprescri* OR inappropriate* OR withdraw* OR withdrew OR ceas* OR cessation OR withheld OR withhold OR discontinu* OR reduc* OR taper* OR stop OR stopping OR stopped OR end OR ending OR ended OR remove* OR removal OR removing)) OR AB ((medication* OR medicin* OR prescription* OR prescrib* OR polypharmacy* OR pharmaceutical* OR drug OR drugs OR “individual drug name or class”) N3 (deprescri* OR inappropriate* OR withdraw* OR withdrew OR ceas* OR cessation OR withheld OR withhold OR discontinu* OR reduc* OR taper* OR stop OR stopping OR stopped OR end OR ending OR ended OR remove* OR removal OR removing)))
Note: Remember to replace phrase in red with the individual drug name or class after you copy the text into the search bar.
Many search terms for the part of the search looking for “older people” were borrowed from the Aged filter shared by the Dutch Library Association https://blocks.bmi-online.nl/catalog/7.
B. Search strategies for PubMed
Search 1 — This search is general and does not include any drug names or drug classes.
It is the same search as Search 1 above, but translated for PubMed.
The general approach is Older People AND Deprescribing.
(“Aged”[mesh] OR “Health Services for the Aged”[mesh] OR “Geriatric Assessment”[mesh] OR “Geriatrics”[mesh] OR “Geriatric Psychiatry”[mesh] OR “Geriatric Nursing”[mesh] OR “Geriatric Dentistry”[mesh] OR “Dental Care for Aged”[mesh] OR “Homes for the Aged”[mesh] OR “Nursing Homes”[mesh] OR “Housing for the Elderly”[mesh] OR elder[tiab] OR elders[tiab] OR eldest[tiab] OR elderly[tiab] OR geriatric*[tiab] OR “old age”[tiab] OR “oldest old”[tiab] OR “senior citizen*”[tiab] OR “very old”[tiab] OR septuagenarian*[tiab] OR octogenarian*[tiab] OR octagenarian*[tiab] OR nonagenarian*[tiab] OR centarian*[tiab] OR centenarian*[tiab] OR supercentenarian*[tiab] OR “older people”[tiab] OR “older person”[tiab] OR “older subject*”[tiab] OR “older patient*”[tiab] OR “older age*”[tiab] OR “older adult*”[tiab] OR “older man”[tiab] OR “older men”[tiab] OR “older male*”[tiab] OR “older woman”[tiab] OR “older women”[tiab] OR “older female*”[tiab] OR “older veterans”[tiab] OR “older population”[tiab])
AND
(“Deprescriptions”[mesh] OR “Inappropriate Prescribing”[mesh] OR “Drug Utilization Review”[Majr:NoExp] OR deprescri*[tiab] OR “de prescribing”[tiab] OR “de prescription*”[tiab] OR “inappropriate prescri*”[tiab] OR “over prescribing”[tiab] OR “inappropriate medication*”[tiab])
Note: To combine the results of Search 1 and Search 2, insert “OR” between them at this point – as in (Older People AND Deprescribing) OR (Older People AND Deprescribing)
Search 2 — This search can be tailored to include any specific drug names or drug classes.
The general approach is Older People AND Deprescribing. In this search, terms relating to deprescribing or withdrawing and terms relating to drugs must be in the article title or abstract. This search is not comparable to Search 1 above because proximity searching is not possible in PubMed. Also, some of the terms relating to stopping medication (removing, reducing, ending) are excluded because of the large number of references where these words are used in a different context. This search is not as precise or as thorough as the search designed for EBSCO Medline, but it will retrieve a large number of relevant references.
(“Aged”[mesh] OR “Health Services for the Aged”[mesh] OR “Geriatric Assessment”[mesh] OR “Geriatrics”[mesh] OR “Geriatric Psychiatry”[mesh] OR “Geriatric Nursing”[mesh] OR “Geriatric Dentistry”[mesh] OR “Dental Care for Aged”[mesh] OR “Homes for the Aged”[mesh] OR “Nursing Homes”[mesh] OR “Housing for the Elderly”[mesh] OR elder[tiab] OR elders[tiab] OR eldest[tiab] OR elderly[tiab] OR geriatric*[tiab] OR “old age”[tiab] OR “oldest old”[tiab] OR “senior citizen*”[tiab] OR “very old”[tiab] OR septuagenarian*[tiab] OR octogenarian*[tiab] OR octagenarian*[tiab] OR nonagenarian*[tiab] OR centarian*[tiab] OR centenarian*[tiab] OR supercentenarian*[tiab] OR “older people”[tiab] OR “older person”[tiab] OR “older subject*”[tiab] OR “older patient*”[tiab] OR “older age*”[tiab] OR “older adult*”[tiab] OR “older man”[tiab] OR “older men”[tiab] OR “older male*”[tiab] OR “older woman”[tiab] OR “older women”[tiab] OR “older female*”[tiab] OR “older veterans”[tiab] OR “older population”[tiab])
AND
((medication*[tiab] OR medicin*[tiab] OR prescription*[tiab] OR prescrib*[tiab] OR polypharmacy*[tiab] OR pharmaceutical*[tiab] OR drug[tiab] OR drugs[tiab] OR “individual drug name or class”[tiab]) AND (deprescri*[tiab] OR inappropriate*[tiab] OR withdraw*[tiab] OR withdrew[tiab] OR withheld[tiab] OR withhold[tiab] OR discontinu*[tiab] OR taper*[tiab])
Note: Remember to replace phrase in red with the individual drug name or class after you copy the text into the search bar.
A team of researchers at Nantes University in France recently developed and validated deprescribing search filters for Medline and Embase using an “objective” methodology to generate search terms. The “objective” methodology/search term identification process was achieved through frequency analysis, or the calculation of how frequently each term appeared in the development set of relevant articles. Researchers then explored the performance of these search terms on a larger reference set of relevant articles.
The Medline search filter, with 34 terms and 4 MeSH terms, had a sensitivity of 92% (95% CI: 83-97%). The Embase search filter, with 27 terms and 6 Emtree terms, had a sensitivity of 91% (95% CI: 82-96%). We wanted to share this alternative approach for researchers conducting deprescribing reviews. The research team recommends adding specific medication or population terms for better search results:
Deprescribing search filter for Medline via PubMed:
“deprescrib*”[Title/Abstract] OR “deprescriptions”[MeSH Terms] OR ((“medication*”[Title/Abstract] OR “prescribing”[Title/Abstract]) AND “inappropriate”[Title/Abstract]) OR “polypharmacy”[Title/Abstract] OR “discontinu*”[Title/Abstract] OR (“withdraw*”[Title/Abstract] AND “medication*”[Title/Abstract]) OR ((“medication*”[Title/Abstract] OR “drugs”[Title/Abstract] OR “prescribing”[Title/Abstract] OR “inappropriate”[Title/Abstract]) AND “reduc*”[Title/Abstract]) OR “inappropriate prescribing”[MeSH Terms] OR (“review*”[Title/Abstract] AND “medication”[Title/Abstract]) OR (“dose reduction”[Title/Abstract] OR “taper*”[Title/Abstract])
Deprescribing search filter for Embase via Embase.com:
‘deprescrib*’:ab,ti OR ((review* NEAR/3 medication*):ab,ti) OR (((medication* OR medicines OR prescribing) NEAR/4 inappropriate):ab,ti) OR ‘potentially inappropriate’:ab,ti OR ((reduc* NEAR/5 medication*):ab,ti) OR ‘polypharmacy’:ab,ti OR ‘discontinu*’:ab,ti OR ‘withdraw*’:ab,ti OR ((reducing NEAR/1 (drug* OR inappropriate OR frid)):ab,ti) OR ‘polypharmacy’/de OR ‘medication therapy management’/de OR ‘dose reduction’:ab,ti OR ‘taper*’:ab,ti OR ‘drug withdrawal’/de OR ‘deprescription’/de OR ‘inappropriate prescribing’/de
Please find the full article here.
