Deprescription Pharmacists Convinced Yet Hindered in Practice

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Pharmacists in France are increasingly convinced of the benefits of deprescription but face significant barriers to implementing the practice, according to a report by Le Moniteur des pharmacies. The publication highlights growing recognition among pharmacy professionals of the need to reduce unnecessary medications, particularly in elderly populations, but identifies systemic and logistical challenges that hinder progress.

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Why deprescription matters in French healthcare
Deprescription—the process of safely reducing or discontinuing medications—has gained traction as a strategy to address overmedication, a known risk factor for adverse drug events. In France, where polypharmacy (the use of multiple medications) is prevalent among older adults, the practice aligns with broader efforts to improve patient safety. The Le Moniteur des pharmacies report notes that 78% of surveyed pharmacists agree deprescription is essential for reducing harm, citing evidence that inappropriate medication use contributes to hospitalizations and mortality.

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However, despite this consensus, pharmacists report limited capacity to act on their convictions. The report attributes this to fragmented communication between pharmacists and physicians, a lack of standardized protocols, and time constraints in busy pharmacy settings. "Pharmacists often lack the authority to recommend medication changes without physician approval," the article states, quoting a representative from the French Pharmacists’ Federation. "This creates a bottleneck in implementing deprescription, even when it is clinically justified."

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Barriers to implementation
The Le Moniteur des pharmacies analysis identifies several key obstacles. First, many pharmacists lack training in deprescription techniques, despite its increasing emphasis in medical education. Second, reimbursement models in France do not incentivize deprescription, with pharmacists paid per prescription rather than for counseling or follow-up. Third, patient and caregiver resistance remains a challenge, as some individuals fear that reducing medications could worsen their health.

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A 2023 study published in Pharmacoepidemiology and Drug Safety supports these findings, noting that 62% of French pharmacists reported insufficient guidance on deprescription from medical professionals. The study also found that only 34% of pharmacies had formal procedures for discussing deprescription with patients, highlighting a gap in institutional support.

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Comparative context: How France stacks up globally
France’s experience with deprescription mirrors trends in other European countries, where similar barriers persist. In the United Kingdom, for example, the National Health Service (NHS) has launched initiatives to train pharmacists in deprescription, but implementation varies widely. A 2024 report by the European Medicines Agency noted that while 85% of European pharmacists view deprescription as important, only 40% feel equipped to lead such efforts.

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In contrast, the United States has seen more structured approaches, with some states introducing legislation to expand pharmacists’ roles in medication reviews. California’s 2022 law, for instance, allows pharmacists to conduct deprescription consultations under specific guidelines. However, such models face resistance in France due to regulatory and cultural differences in healthcare delivery.

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What comes next for deprescription in France?
The Le Moniteur des pharmacies report calls for policy reforms to address the challenges facing pharmacists. Recommendations include mandatory deprescription training for pharmacy students, financial incentives for deprescription consultations, and clearer guidelines for interprofessional collaboration. A spokesperson for the French Ministry of Health told the publication that the government is reviewing proposals to integrate deprescription into national health strategies but emphasized the need for "careful implementation to avoid unintended consequences."

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Public health experts caution that deprescription requires a nuanced approach. "It’s not about stopping all medications," said Dr. Sophie Lefevre, a geriatrician at the University of Paris, in an interview with Le Moniteur des pharmacies. "It’s about ensuring each medication is necessary and beneficial. This requires time, communication, and a shift in how we view medication use."

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Why this issue matters for patients
The stakes for patients are high. A 2022 review in The Lancet Healthy Longevity found that deprescription can reduce falls, cognitive decline, and hospital admissions among older adults. In France, where 40% of adults aged 65 and older take five or more medications, the potential impact is significant. However, without systemic changes, pharmacists’ enthusiasm for deprescription may remain unfulfilled.

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As the debate continues, the Le Moniteur des pharmacies report underscores a critical tension: the gap between professional belief and practical action. For pharmacists, the challenge is not just about advocating for deprescription but about navigating a healthcare system that has yet to fully recognize their role in this evolving practice.

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"Pharmacists are at the front line of medication management, but we need the tools and support to make deprescription a reality," said a pharmacist interviewed for the report. "Otherwise, our