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Peer-reviewedCC BY 4.0International Journal of Clinical Pharmacy

A qualitative analysis to identify implementation strategies for a deprescribing clinical practice guideline using the CFIR-ERIC Matching Tool: perspectives from consumers and professional stakeholders

  • Hui Wen Quek1
  • Xisco Reus1
  • Kenneth Lee1
  • Veronika Seda2,3
  • Leon Adams4,5
  • Osvaldo P. Almeida6,7
  • Gillian E. Caughey8,9
  • Jennifer Gowan10,11
  • Kerryn Hart12
  • Andrew Heredia13
  • Anne-Marie Hill6
  • Lisa Kalisch Ellett14
16 more authors
  • Dina LoGiudice15,16,17
  • Arduino A. Mangoni9,18
  • Anthony Marinucci19
  • Treasure McGuire20,21,22
  • Nilufeur McKay23,24
  • Vasi Naganathan25,26
  • Christopher Ng5,9,27
  • Maz Osborne28
  • Kevan R. Polkinghorne29,30
  • Constance D. Pond31
  • Sepehr Shakib32,33
  • Angela Shiu34,35
  • Andrew Stafford36
  • Tim Whitmore24
  • Christopher Etherton-Beer6,24
  • Amy Page1
36 affiliations
  1. 1Centre for Optimisation of Medicines, School of Health and Clinical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009 Australia
  2. 2Department for Health and Wellbeing, Adelaide, Australia
  3. 3The University of Sydney, Sydney, Australia
  4. 4Sir Charles Gairdner Hospital, Perth, Australia
  5. 5The University of Western Australia, Perth, Australia
  6. 6Western Australian Centre for Health and Ageing, The University of Western Australia, Perth, Australia
  7. 7Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
  8. 8Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute, Adelaide, Australia
  9. 9Flinders University, Adelaide, Australia
  10. 10Gowan & Associates Pty Ltd, Melbourne, Australia
  11. 11Monash University, Melbourne, Australia
  12. 12School of Medicine (Optometry), Deakin University, Waurn Ponds, Australia
  13. 13Australian Dental Association Victorian Branch, Melbourne, Australia
  14. 14Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, The University of South Australia, Adelaide, Australia
  15. 15The Royal Melbourne Hospital, Melbourne, Australia
  16. 16The University of Melbourne, Melbourne, Australia
  17. 17Victorian Aboriginal Health Service, Melbourne, Australia
  18. 18Southern Adelaide Local Health Network, Adelaide, Australia
  19. 19Royal Australian College of General Practitioners, Melbourne, Australia
  20. 20School of Pharmacy and Pharmaceutical Sciences, The University of Queensland, Brisbane, Australia
  21. 21Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
  22. 22Mater Health SEQ, South Brisbane, Australia
  23. 23School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
  24. 24Royal Perth Hospital, Perth, Australia
  25. 25Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Hospital and Concord Clinical School, Sydney, Australia
  26. 26Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
  27. 27Blacktown Hospital, Sydney, Australia
  28. 28Consumer/Carer Representative, Perth, Australia
  29. 29Department of Nephrology, Monash Health, Melbourne, Australia
  30. 30Department of Medicine, Monash University, Melbourne, Australia
  31. 31Wicking Dementia Research and Training Centre, The University of Tasmania, Hobart, Australia
  32. 32Northern Adelaide Local Health Network, Adelaide, Australia
  33. 33Adelaide University, Adelaide, Australia
  34. 34Advanced Pharmacy Australia, Melbourne, Australia
  35. 35Austin Health, Better@Home Subacute Program, Melbourne, Australia
  36. 36Curtin Medical School and enAble Institute, Curtin University, Perth, Australia
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Abstract

Introduction: Deprescribing is the planned withdrawal or dose reduction of medicines when harms outweigh benefits or when they are no longer required. Following publication of the Clinical Practice Guideline for Deprescribing in Older People in September 2025, supporting its uptake into routine practice is a critical next step.

Aim: This study aimed to identify implementation strategies, informed by stakeholder-perceived barriers, to support the implementation of deprescribing guidelines.

Method: A qualitative analysis was undertaken of open-text responses collected during the guideline public consultation (24 April–31 May 2025). Inductive thematic analysis identified implementation barriers, which were then deductively mapped to the Consolidated Framework for Implementation Research (CFIR). Relevant CFIR constructs were entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool to generate implementation strategies. Strategies were ranked by cumulative percentage endorsement and grouped using ERIC concept-mapping clusters.

Results: Of 313 survey respondents, 248 provided responses relevant to implementation. Three barrier themes were shared across consumer and professional/policy stakeholder groups. Theme 1: ‘Knowledge gaps, beliefs, and limited readiness to deprescribe’ describes gaps in consumers’ and clinicians’ knowledge, beliefs about medication use and deprescribing, and limited confidence or willingness to engage in deprescribing. Theme 2: ‘Communication, hierarchy, or social influences limiting deprescribing’ describes communication gaps, entrenched prescribing norms, power imbalances, and social influences that limited shared decision-making. Theme 3: ‘System-level structures misaligned with deprescribing practice’ describes broader healthcare system barriers, including financial, policy, workforce, organisational, and information-related constraints. Consumers additionally highlighted a lack of person-centred and adaptable approach for deprescribing, while professional/policy stakeholders identified barriers related to medicine formulations and guideline format and usability. Barriers mapped predominantly to the CFIR Inner Setting domain. The highest-ranked implementation strategy was ‘Identify and prepare champions’, within the ‘Develop stakeholder interrelationships’ cluster.

Conclusion: Deprescribing barriers were largely situated within the Inner Setting domains. Recommended strategies emphasised stakeholder engagement and local champions, supporting locally led, relationship-based implementation approaches. Future work should evaluate the feasibility, acceptability, and effectiveness of these strategies in practice.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11096-026-02218-9.

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Cite

BibTeXRIS
BibTeX
@article{quek2026qualitative,
  title = {{A qualitative analysis to identify implementation strategies for a deprescribing clinical practice guideline using the CFIR-ERIC Matching Tool: perspectives from consumers and professional stakeholders}},
  author = {Hui Wen Quek and Xisco Reus and Kenneth Lee and Veronika Seda and Leon Adams and Osvaldo P. Almeida and Gillian E. Caughey and Jennifer Gowan and Kerryn Hart and Andrew Heredia and Anne-Marie Hill and Lisa Kalisch Ellett and Dina LoGiudice and Arduino A. Mangoni and Anthony Marinucci and Treasure McGuire and Nilufeur McKay and Vasi Naganathan and Christopher Ng and Maz Osborne and Kevan R. Polkinghorne and Constance D. Pond and Sepehr Shakib and Angela Shiu and Andrew Stafford and Tim Whitmore and Christopher Etherton-Beer and Amy Page},
  journal = {International Journal of Clinical Pharmacy},
  year = {2026},
  month = sep,
  doi = {10.1007/s11096-026-02218-9},
  url = {https://doi.org/10.1007/s11096-026-02218-9},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A qualitative analysis to identify implementation strategies for a deprescribing clinical practice guideline using the CFIR-ERIC Matching Tool: perspectives from consumers and professional stakeholders
AU  - Hui Wen Quek
AU  - Xisco Reus
AU  - Kenneth Lee
AU  - Veronika Seda
AU  - Leon Adams
AU  - Osvaldo P. Almeida
AU  - Gillian E. Caughey
AU  - Jennifer Gowan
AU  - Kerryn Hart
AU  - Andrew Heredia
AU  - Anne-Marie Hill
AU  - Lisa Kalisch Ellett
AU  - Dina LoGiudice
AU  - Arduino A. Mangoni
AU  - Anthony Marinucci
AU  - Treasure McGuire
AU  - Nilufeur McKay
AU  - Vasi Naganathan
AU  - Christopher Ng
AU  - Maz Osborne
AU  - Kevan R. Polkinghorne
AU  - Constance D. Pond
AU  - Sepehr Shakib
AU  - Angela Shiu
AU  - Andrew Stafford
AU  - Tim Whitmore
AU  - Christopher Etherton-Beer
AU  - Amy Page
PY  - 2026
DA  - 2026/09/03
JO  - International Journal of Clinical Pharmacy
DO  - 10.1007/s11096-026-02218-9
UR  - https://doi.org/10.1007/s11096-026-02218-9
AB  - Introduction: Deprescribing is the planned withdrawal or dose reduction of medicines when harms outweigh benefits or when they are no longer required. Following publication of the Clinical Practice Guideline for Deprescribing in Older People in September 2025, supporting its uptake into routine practice is a critical next step.  Aim: This study aimed to identify implementation strategies, informed by stakeholder-perceived barriers, to support the implementation of deprescribing guidelines.  Method: A qualitative analysis was undertaken of open-text responses collected during the guideline public consultation (24 April–31 May 2025). Inductive thematic analysis identified implementation barriers, which were then deductively mapped to the Consolidated Framework for Implementation Research (CFIR). Relevant CFIR constructs were entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool to generate implementation strategies. Strategies were ranked by cumulative percentage endorsement and grouped using ERIC concept-mapping clusters.  Results: Of 313 survey respondents, 248 provided responses relevant to implementation. Three barrier themes were shared across consumer and professional/policy stakeholder groups. Theme 1: ‘Knowledge gaps, beliefs, and limited readiness to deprescribe’ describes gaps in consumers’ and clinicians’ knowledge, beliefs about medication use and deprescribing, and limited confidence or willingness to engage in deprescribing. Theme 2: ‘Communication, hierarchy, or social influences limiting deprescribing’ describes communication gaps, entrenched prescribing norms, power imbalances, and social influences that limited shared decision-making. Theme 3: ‘System-level structures misaligned with deprescribing practice’ describes broader healthcare system barriers, including financial, policy, workforce, organisational, and information-related constraints. Consumers additionally highlighted a lack of person-centred and adaptable approach for deprescribing, while professional/policy stakeholders identified barriers related to medicine formulations and guideline format and usability. Barriers mapped predominantly to the CFIR Inner Setting domain. The highest-ranked implementation strategy was ‘Identify and prepare champions’, within the ‘Develop stakeholder interrelationships’ cluster.  Conclusion: Deprescribing barriers were largely situated within the Inner Setting domains. Recommended strategies emphasised stakeholder engagement and local champions, supporting locally led, relationship-based implementation approaches. Future work should evaluate the feasibility, acceptability, and effectiveness of these strategies in practice.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11096-026-02218-9.
SN  - 2210-7703
SN  - 2210-7711
ER  -