Table 4 Recommendations for practice, based on Normalisation Process Theory (NPT) [66]

Coherence/sense-making

The extent to which study participants made sense of, and had a clear knowledge and understanding of the intervention

- Education for patients and carers on the rationale for deprescribing medications

- HCPs training (experiential, MDT, direct patient care tasks)

- Clear roles and responsibilities of the MDT team members

- Familiarity of the role of pharmacists within primary care

Cognitive Participation

The extent to which participants bought into the intervention, engaged with it and committed to it

- Integration and co-location of pharmacists in primary care teams

- Utilising the skills of different HCPs (e.g. nurses, social prescribers, frailty practitioners)

- Involvement of informal carers

- Building trusting relationship between the different HCPs

Collective Action

The allocation of organisational and personal resources to interventions, how the intervention was operationalised and the definition of roles and responsibilities

- Prioritising high-risk patients using practice systems

- Offering deprescribing as a trial off medication or ‘drug holiday’

- Start with ‘quick wins’

- Tailored mode of communication (Face-to-face appointments vs telephone and home visits)

- Taking into account patient preferences and goals (person-centred approach)

- Aligning structured medication reviews with other appointments

- Using deprescribing tools (eg STOPP/START)

- Good communication between the team members (asynchronous vs synchronous)

- Access to and documentation in medical records

Reflexive Monitoring

The extent to which the interventions were subjected to appraisal and evaluation, assessments of interventional impact, and processes of reflection, learning, and refinement to ensure sustained change

- Monitoring and follow up of patients