Déprescription et responsabilité médicale

Abstract

Deprescribing aim to improve the clinical condition of patients, through progressively reducing and/or discontinuing certain drug treatments. This paper reports its conceptual genesis and gradual diffusion, the dynamics of practitioners/healthcare insurer agreements in France, and medical liability. Irrespective of any incentive agreement, consideration of the advisability of de-prescribing has become mandatory in situations where iatrogenic risks are well established – particularly in the case of multi-medication treatments: as knowledge grows, failure to deprescribe (or to consider the advisability of doing so) could be considered a fault. However, de-prescribing is not a quantitative approach, due to its clinical purpose and consequences: it requires gathering scattered data, prioritizing treatments, planning, and sometimes arbitrating between therapeutic intentions. Interprofessional collaboration is then served by new tools and informed by experience-sharing: they alone can meet the clinical and societal challenge of deprescribing, while dedicated algorithms and AI are coming.