As healthcare systems contend with an ageing population and an escalating burden of polypharmacy, deprescribing continues to be an important yet underutilised strategy for optimising patient care. Here, Gerry Hughes discusses DIAMOND – a new research programme using real-world data to support safer medication management – and how hospital pharmacists should support deprescribing efforts.
Described as the process of withdrawal of an inappropriate medication, supervised by a healthcare professional, with the goal of managing polypharmacy and improving outcomes, deprescribing is a crucial part of best practice. It offers a practical pathway to reduce adverse drug events, enhance medication adherence and align prescribing practices with patient goals.
Yet despite its promise, deprescribing remains inconsistently implemented across clinical settings. Healthcare professionals often lack the robust evidence, definitional clarity, and decision-support tools necessary to deprescribe with confidence.
Hospital pharmacists are ideally placed to lead the advancement of deprescribing practices to tackle polypharmacy. However, to fulfil this potential, they must access tools that leverage real-world data, digital technologies and advanced analytical methods. Meeting this critical need is the central ambition of the DIAMOND research programme.
DIAMOND, or Developing Innovative Analytical Methods for research ON Deprescribing, seeks to establish tools, evidence and guidance that can support both research and real-world practice. Funded through a prestigious €2.4m Wellcome Career Development Award, the eight-year initiative is led by principal investigator Professor Frank Moriarty, who is associate professor at the School of Pharmacy and Biomolecular Sciences and institutional lead for open research at the Royal College of Surgeons in Ireland.
Reflecting on the unmet needs that prompted the original concept for the programme, Professor Moriarty notes two particular factors.
‘First, deprescribing often doesn’t happen in practice, in part due to lack of evidence on the effects of deprescribing both potential harms and benefits,’ he explains. ‘The second gap was that some methods for understanding the effects of health interventions using real-world data had not yet been extended to deprescribing research.’
Digital innovation meets clinical complexity
In recent years, advances in electronic health records (EHRs), machine learning and pharmacoepidemiological methods have created new opportunities to study and support deprescribing. For example, target trial emulation methods, originally developed for causal inference using observational data, are now being applied to questions around medication discontinuation. However, their use in deprescribing research remains limited.
‘Trials to understand the effects of deprescribing can be challenging to conduct,’ Professor Moriarty says. ‘They can be resource-intensive, incentives are lacking to generate new evidence, and the relevant patients may be hard to recruit. That’s why we’re investigating the potential for real-world data to help generate this evidence on deprescribing.’
Clinicians and researchers have also struggled to consistently define what counts as deprescribing within real-world datasets. For example, was a medication stopped due to an adverse event, a deliberate deprescribing effort or patient non-adherence?
Building the evidence base for deprescribing
DIAMOND brings together a multidisciplinary team of clinical, methodological and digital health experts from across Europe and North America, including collaborators from University College Cork in Ireland, Queen’s University Belfast and University College London in the UK, the University of British Columbia in Canada, and Complutense University of Madrid in Spain.
‘Our collaborators are adding a combination of methodological expertise, including approaches to evaluate statistical methods, clinical expertise on deprescribing practice in different regions, and translating evidence into clinical practice,’ says Professor Moriarty. ‘These perspectives will hopefully help to increase the impact of the programme.’
Their aim is to strengthen the scientific foundations of deprescribing to overcome the burden of polypharmacy by focusing on three key priorities:
Characterising deprescribing in routine data
Work is already underway on a scoping review of how deprescribing is defined across published studies using real-world datasets. These definitions will be tested against primary care datasets for medications associated with high risk in older adults: benzodiazepines, low-dose aspirin, and selective serotonin reuptake inhibitors (SSRIs). Patterns in deprescribing and factors influencing it – such as GP preferences or adverse events – will be analysed.
Applying target trial emulation to deprescribing
This work package will focus on simulation studies to test how well target trial emulation methods can be applied to deprescribing scenarios. Synthetic datasets with known effects will be used to benchmark the accuracy of different modelling approaches, with a focus on clinical outcomes such as bleeding risk and mortality. Findings will inform guidance for future deprescribing studies and support the development of an open-source R package for statistical computing to increase usability.
Mapping serotonergic burden and risk
Serotonin syndrome is a potentially life-threatening reaction linked to serotonergic medicines, especially when used in combination. Work on this priority involves synthesising global pharmacovigilance data, defining medications most associated with serotonin syndrome, and developing a clinically usable risk index. This index will support stratified analyses to determine how deprescribing SSRIs affects patients with varying levels of serotonergic burden.
Practical tools for real-world impact
The DIAMOND research programme commits to sharing all methods, tools and code through open-access platforms, enabling replication and uptake across healthcare. This aligns with its broader vision: to ensure that deprescribing decisions can be guided by evidence that is both rigorous and relevant.
The implications for safe and effective prescribing are substantial. As the medication safety agenda continues to expand, pharmacists in particular will increasingly be called upon to guide deprescribing practices. Tools that integrate seamlessly with EHRs, support risk stratification and provide evidence-informed guidance will be essential in that continuing endeavour.
‘We would hope that once developed, the serotonergic burden index could be used as part of structured medication reviews delivered by pharmacists, and ultimately, this could be integrated into computerised decision support to apply this to patient record data in practice,’ Professor Moriarty adds.
A call to action for deprescribing
Deprescribing is central to the safe, effective and patient-centred use of medicines in modern healthcare. The DIAMOND programme represents a bold step forward in leveraging digital innovation and methodological rigour to support pharmacy practice and improve patient outcomes.
For hospital pharmacists, this is an opportunity to lead from the front to tackle polypharmacy. Engaging with DIAMOND’s findings, tools and training resources can help embed deprescribing into daily practice and ensure that patients benefit from medication regimens that are not just necessary, but optimal.
As Professor Moriarty concludes: ‘I think hospital pharmacists have a huge potential role in acting as catalysts for deprescribing in practice and developing and championing innovative models of medicines optimisation for patients.’
