Medication review, patient goals, fragmented care and the future of appropriate prescribing were among the major themes discussed at the International Conference on Deprescribing (ICOD) 2026 in Montréal. Irish Pharmacy News spoke with pharmacist and UCC researcher Dr Perrine Evrard about the evolving conversation around deprescribing, and why pharmacists have a central role to play.
Dr Perrine Evrard, pharmacist, PhD and postdoctoral researcher at University College Cork
Source: Irish Pharmacy News, June 2026, pages 36 and 38.
As healthcare systems grapple with multimorbidity, ageing populations and increasingly complex medication regimens, the question is no longer simply whether patients are receiving too many medicines. Increasingly, the focus is shifting towards a more nuanced challenge: are medicines still appropriate for the patient in front of us?
That broader conversation was at the heart of the International Conference on Deprescribing (ICOD) 2026, held in Montréal, Canada, from 27–29 April.
Building on the success of previous conferences in Denmark and France, ICOD 2026 brought together clinicians, researchers, pharmacists, nurses, physicians, policymakers and patient representatives committed to improving medication use and medication appropriateness.
Among the contributors was Dr Perrine Evrard, pharmacist, PhD and postdoctoral researcher at University College Cork, whose work focuses on deprescribing interventions, behaviour change and the factors influencing prescribing decisions.
Reflecting on the event, she described ICOD as a uniquely focused international meeting.
“I think it’s the only one actually that’s really focused on deprescribing,” she said.
Importantly, however, the conference reinforced that deprescribing is far from being solely a pharmacy issue.
“You need to have everyone on board,” Evrard noted.
That multidisciplinary ethos shaped many of the key themes emerging from Montréal — themes with clear implications for both hospital and community pharmacy practice in Ireland.
From “Overprescribing” to Appropriate Prescribing
One of the strongest messages from ICOD 2026 was a subtle but important reframing of the conversation around medicines.
For years, much discussion about deprescribing has centred on overprescribing and reducing medication burden. However, speakers increasingly emphasised a shift towards the broader concept of appropriate prescribing.
“I think there’s a shift a little, but we move from overprescribing to really appropriate prescribing because we realised too that for some patients it is appropriate to have this high number of medication,” said Evrard.
This distinction matters.
Polypharmacy remains highly prevalent, particularly among older adults and people living with multiple chronic conditions. Patients taking five, ten or more medicines daily are now a familiar reality across healthcare settings.
Yet medication count alone does not tell the full story.
Many medicines are initiated appropriately according to disease-specific clinical guidelines. Problems often emerge because healthcare systems excel at starting treatments, but may be less effective at reassessing them over time.
As discussed at ICOD, polypharmacy can sometimes become the unintended consequence of good healthcare: medicines accumulate through guideline-driven prescribing, while multimorbidity, changing priorities and opportunities for review receive less attention.
For pharmacists, this reflects a challenge encountered every day in practice.
Deprescribing is not about stopping medicines for the sake of achieving a lower number on a medication list. Rather, it involves asking whether each medicine continues to offer meaningful benefit, aligns with current goals of care and maintains an acceptable balance between benefit and burden.
When Patients Don’t Like the Word “Deprescribing”
Language emerged as another major conference theme — and one with important implications for patient communication.
According to Evrard, patient representatives consistently highlighted discomfort with the term deprescribing itself.
“It has been clear from the beginning that all patient representatives… stated that they don’t like the word deprescribing,” she explained.
Within healthcare professions, the term has become commonplace. However, patients may interpret it differently.
For some, “deprescribing” may sound like withdrawal of care, cost-saving, or having medicines removed without sufficient explanation.
Healthcare professionals appear to recognise this distinction in practice.
“They use it between themselves when we talk about it, but maybe not directly with patients,” Evrard observed.
Alternative terminology discussed at the conference included concepts such as “right-sizing”, “desintensification” and “appropriateness”, although no universally accepted replacement emerged.
The discussion highlights an important consideration for pharmacists involved in medication review conversations.
How discussions are framed matters.
Patients may respond differently to questions such as:
“Is this medicine still helping?”
“Does this treatment still fit your goals?”
“Should we review whether this medicine is still needed?”
These approaches position medication review as a collaborative process centred on benefit and patient priorities, rather than simply removing treatment.
Medicines Must Align with Patient Goals
Patient-centred care was another recurring theme throughout ICOD 2026.
A key message emerging from conference discussions was that medicines should be aligned not only with clinical guidelines, but also with patient values, preferences and goals of care.
This may sound straightforward, but in practice it raises challenging questions.
What matters most to the patient?
Is the priority longevity, symptom relief, independence, reduced pill burden, quality of life, or minimising treatment side-effects?
The answers may differ substantially from one patient to another.
Conference speakers stressed the importance of ensuring patients understand what medicines are intended to achieve and how treatment decisions relate to their broader healthcare goals.
For pharmacists, this reinforces the growing importance of shared decision-making within medication optimisation and medicines review services.
Deprescribing is not simply a technical exercise driven by prescribing criteria, algorithms or risk calculations.
Communication, trust and patient understanding remain fundamental.
Importantly, patient-centred prescribing does not always lead to fewer medicines.
As highlighted during conference discussions, aligning medicines with patient priorities may result in deprescribing in some situations — but additional prescribing in others.
The central issue is not medicine reduction. It is ensuring treatment decisions make sense for the individual patient.
Deprescribing Is a Process — Not a Single Intervention
One of the most practical messages emerging from Montréal concerned how deprescribing happens in real-world clinical practice.
Deprescribing is rarely a one-off event.
Instead, it is typically an ongoing process involving identification, assessment, discussion, planning, implementation and follow-up.
This process creates multiple opportunities for pharmacy involvement.
According to Evrard, pharmacists can contribute in several ways: identifying medicines suitable for review, communicating with prescribers, applying tools such as STOPP/START criteria, educating patients, supporting medication changes and monitoring for withdrawal symptoms or emerging concerns.
These responsibilities extend across the healthcare continuum.
Community pharmacists may be particularly well positioned to identify long-term repeat prescribing, medicine-related adverse effects, concerns raised during dispensing encounters or confusion following medication changes.
Hospital pharmacists, meanwhile, continue to play essential roles in medicines reconciliation, clinical review, discharge planning and communication around medication changes during transitions of care.
The conference message was clear: successful deprescribing depends on collaboration, continuity and follow-up rather than isolated interventions.
For Irish pharmacy, that message carries particular relevance.
Fragmented Care Remains a Major Barrier
Across healthcare systems internationally, fragmented care continues to pose a significant barrier to medication appropriateness.
Patients frequently navigate between hospital teams, GPs, outpatient specialists, nursing homes and community pharmacy — often becoming the default coordinators of their own medication information.
Conference discussions highlighted the consequences of this fragmentation: outdated medication lists, unclear prescribing intentions, duplicated therapies and poor communication regarding medication changes.
For pharmacists working in Ireland, these challenges will be familiar.
Community pharmacists are often among the healthcare professionals who maintain the most regular contact with patients after hospital discharge, consultant appointments or GP medication reviews.
This places them in a critical position to support continuity of care.
Clarifying medication changes, identifying discrepancies, supporting patient understanding and helping maintain accurate medication records are already integral aspects of pharmacy practice.
There is also a clear hospital pharmacy dimension.
Medicines reconciliation, discharge communication and improved coordination between acute hospitals, GPs and community pharmacy remain essential components of safer prescribing and deprescribing.
The message from ICOD 2026 was unmistakable: deprescribing cannot be separated from wider discussions about communication, transitions of care and integrated healthcare delivery.
Digital Tools: Helpful, But Not a Cure-All
Technology features prominently in deprescribing conversations around supporting medication appropriateness.
Digital prompts, clinical reminders and decision-support tools may offer opportunities to encourage clinicians to consider medication review and deprescribing.
One familiar challenge is alert fatigue.
“You cannot have too many alerts because of alert fatigue,” Evrard cautioned.
For pharmacists working within increasingly digital prescribing environments, the issue is well recognised.
Excessive, poorly designed or clinically irrelevant alerts risk becoming background noise — potentially reducing rather than improving engagement.
It has been highlighted that tools don’t lack value, but that they must be carefully designed, targeted and clinically meaningful.
As Ireland continues to expand digital healthcare systems, this will remain an important consideration.
A Broader Conversation About Appropriate Medicines Use
Although older adults remain a key focus because of the high prevalence of polypharmacy, ICOD 2026 demonstrated that deprescribing extends well beyond geriatric medicine.
Conference discussions included psychotropics, diabetes therapies, cardiovascular medicines and prescribing considerations across different age groups.
There was particular interest this year in cardiovascular therapies, partly reflecting recent work around statin deprescribing recommendations.
Yet the broader message transcended individual therapeutic areas.
Ultimately, ICOD 2026 positioned deprescribing within a wider movement towards appropriate, patient-centred prescribing — one that acknowledges complexity, values multidisciplinary working and recognises that medicines should evolve alongside patients’ changing circumstances.
For Irish pharmacists, the themes discussed in Montréal are highly relevant.
From medication review and medicines optimisation initiatives to transitions of care and patient communication, pharmacists are increasingly central to ensuring medicines remain safe, appropriate and aligned with patient needs.
The message from ICOD 2026 was clear: deprescribing is no longer simply about reducing medicine numbers.
It is about ensuring every medicine continues to make sense for every patient, at every stage of care.
