Background: Proton pump inhibitors (PPIs) are some of the most frequently prescribed medications, but they are often used inappropriately, either being prescribed without a clear indication or continued for longer than necessary. In such cases, deprescribing is recommended. However, despite its proven effectiveness, the implementation of deprescribing in clinical practice remains inconsistent and varied, making it challenging to identify the most effective strategies. The goal is to provide a comprehensive outline of deprescribing interventions for PPI therapy implemented across various settings and by different healthcare professionals. Methods: The study is designed to be a systematic review of the published literature. PubMed, Embase, and Web of Science databases were searched from 1 January 1989 (the first PPI on the market) to 30 September 2024 for articles assessing PPI deprescribing in adult patients, focusing on the implementation rate (primary outcome) or effects on symptoms (secondary outcome). Results: After screening, 66 studies were included, predominantly pragmatic trials (N = 32) or randomized controlled trials (N = 25). We found a variety of interventions promoting PPI deprescription. Collaborative efforts involving multiple healthcare professionals, the use of algorithms for clinical decision-making, and patient involvement have proven to be key elements in the most effective strategies. Discontinuing therapy may not be advisable in cases of recurrent symptoms, suggesting that on-demand therapy could be a recommended approach. Deprescribing is particularly relevant for individuals with mild illnesses and symptoms, where tapering can effectively mitigate the rebound symptoms often associated with abrupt discontinuation. Conclusions: Given the current prevalence of inappropriate PPI prescribing, it is imperative to raise awareness among both physicians and patients about the importance of the deprescribing process, which should be tailored to the specific needs of each patient, considering his/her medical history, current health status, and personal preferences.

Background: Medication adherence is essential for achieving favorable health outcomes, particularly in older adults with multiple chronic conditions. Objective: This systematic review critically appraised current evidence on interventions aimed at enhancing medication adherence in older adults. Methods: Literature searches were performed in PubMed / MedLine , EMBASE , and Web of Science for articles published up to December 31, 2024. We identified peer‐reviewed studies assessing interventions to improve medication adherence in older adults (≥ 60 years). The primary outcome was intervention effectiveness; secondary outcomes were clinical parameters, disease control, health‐related quality of life, rehospitalization rates, event rates, mortality rates, feasibility, acceptability or satisfaction levels, and overall costs or cost‐effectiveness. Results: A total of 128 studies was included: 96 randomized controlled trials ( RCTs ), 16 pre–post studies, 9 non‐ RCTs , and 7 longitudinal evaluations. The majority (51.2%) was implemented in primary care. An educational component was present in 56.3% of interventions, a technical component in 47.6%, and an attitudinal component in 32.0%. Only 3.2% of interventions included rewards. Various healthcare professionals, such as pharmacists, nurses, and physicians, were involved in delivering interventions. Most studies reported improved adherence, though some factors, such as high baseline adherence, insufficient intervention intensity, and brief follow‐up limited the effectiveness. Secondary outcomes often included improvements in disease knowledge, patient satisfaction, quality of life, and clinical indicators like blood pressure and HbA1c levels. Conclusions: Despite most studies showed a positive impact on adherence, a high heterogeneity was highlighted, and effectiveness was mainly observed in the short term.

Polypharmacy, defined as the concurrent use of multiple medications, increases the risk of various adverse outcomes. However, the variability in definitions across the literature contributes to substantial heterogeneity. Building on the published literature, this study aimed to identify a set of operational definitions of polypharmacy applicable to administrative databases and to assess their association with all-cause hospitalization. Data from the pharmacy refill and hospitalization databases of the Local Health Unit (LHU) of Bergamo, Lombardy, were analyzed. Patients aged ≥40 with at least one reimbursed drug prescription in 2017 were included. Prescription coverage was evaluated using total defined daily doses (DDDs), and all-cause hospitalizations from January to June 2018 were considered. Definitions explored included (i) the WHO’s criterion of ≥5 medications by ATC fourth-level code; (ii) the exclusion of prescriptions usually for short-term treatments; and (iii) drugs with cumulative annual DDD ≥ 60. Approaches were assessed annually, quarterly, and monthly, and logistic regression was used to estimate odds ratios (ORs) for hospitalization risk. Among 431,620 patients, the DDD ≥ 60 definition showed the least variability (20.47–21.16%) and identified an older more complex cohort. All definitions showed a dose-dependent association with hospitalization risk. Different definitions of polypharmacy result in varying prevalence, with DDD ≥ 60 being the most consistent. A patient-centric approach is crucial to assess the appropriateness of polypharmacy.

Background: General practitioners (GPs) should regularly review patients’ medications and, when they are potentially harmful or no longer necessary, implement deprescribing approach. We aimed to assess the perceptions and potential barriers to deprescribing among Italian GPs. Methods: GPs were invited to participate in an observational cross-sectional study through an online survey containing 20 questions addressing attitudes towards deprescribing, including physicians’ perceptions, potential barriers, and how this process is addressed in daily clinical practice. The survey, accessible for responses from 4th May 2023 to 15th January 2024, was distributed through social media, networks, medical associations, and involving primary care departments of local health authorities. Results: Over 8 months, 617 answers were collected. Less than 2% ( n = 11) reported to not implement deprescribing interventions in daily practice, primarily due to perceived insufficient experience ( n = 7) or lack of specific education ( n = 6). Conversely, 23.1%( n = 142) of respondents reported frequently or very frequently implementing deprescribing. Among barriers, GPs reported difficulties in dealing with specialists ( n = 438, 71.7%), distrust of patients in drug discontinuation ( n = 326, 53.4%), poor availability of deprescribing guidelines ( n = 231, 37.8%), and time constraints ( n = 213, 34.9%). Guidelines and targeted training were mostly demanded (by 66.1% and 59.6%, respectively). Regarding specific drug classes, the proportion of GPs reporting to frequently implement deprescribing for proton pump inhibitors was 51.8% ( n = 313), while percentage was lower for benzodiazepines ( n = 166, 27.4%), bisphosphonates ( n = 147, 24.3%), statins ( n = 128, 21.2%), antihypertensives ( n = 108, 17.9%), and antidepressants ( n = 96, 15.9%). Conclusion: The study shows that while GPs recognize the importance of deprescribing, however, they face significant barriers, including a lack in targeted education and specific guidelines to enhance their confidence and knowledge in implementing this process effectively in daily clinical practice.

Background: Medication non‐adherence is common among older adults and represents a major challenge for healthcare systems. Effective interventions are needed to support adherence and inform quality‐improvement efforts. Objective: To assess how medication‐adherence interventions for older adults are currently implemented in Italy and to identify care‐delivery priorities improving quality and feasibility across healthcare settings. Methods: We conducted a mixed‐methods study within the Eldercare project. We administered a national benchmarking survey (May–August 2024) to healthcare professionals and patient representatives from scientific societies, professional orders, public institutions, universities, and patient associations. We ran a nested Strengths, Weaknesses, Opportunities and Threats (SWOT) survey (January–March 2025) with key informants. We summarized quantitative responses, compared distributions across professional roles ( χ ² /Fisher's exact tests), and analyzed SWOT free‐text using a hybrid deductive–inductive Framework Method. Results: In the benchmarking survey ( n = 340), Respondents reported that adherence is mainly addressed during routine consultations (78.5%) and most often relied on direct patient‐provider communication (51.5%). Respondents reported that monitoring is primarily based on clinical data (55.3%) and access to dispensing/prescription data and digital tools was less frequent (generally ≤ 50%). Respondents rated patient‐centered strategies as highly important (e.g., caregiver involvement 94.4%, shared goal setting 90.3%, individual counseling 87.6%), but feasibility ratings were consistently lower. The most frequently reported unmet needs were limited patient awareness (68.8%) and poor coordination among professionals (60.3%). Key barriers included high numbers of daily medicines (69.1%) and lack of clear information on prescribed therapies (64.7%). In the SWOT survey ( n = 14), strengths included continuity and communication, while weaknesses and threats focused on fragmented interprofessional collaboration, limited training, low digitalisation, and scarce financial/institutional support. Conclusions: Medication‐adherence support for older adults in Italy remains largely consultation‐based and variably resourced. Strengthening interprofessional coordination, training, and use of digital/administrative data may help develop more structured and scalable adherence‐support pathways as a quality‐improvement model of care.