Effectiveness of educational interventions in general practice for improving medication appropriateness and deprescribing in older adults: a systematic review protocol

Introduction: Polypharmacy in older adults is a growing concern, particularly in general practice (GP), where general practitioners (GPs) are the main prescribers managing complex multimorbidity. While often necessary, polypharmacy increases the risk of potentially inappropriate prescribing (PIP), adverse drug events, hospitalisations and reduced quality of life. Although clinical medication reviews using specific tools are frequently employed to address these risks and guide a safe deprescribing process, the specific role and effectiveness of educational interventions-as a component of prescribers' behavioural change-remain inconsistently evaluated. The objective of this review is to identify, describe and evaluate educational interventions targeting GPs, aimed at improving medication appropriateness and promoting deprescribing in older adults with polypharmacy in GP settings. Methods and analysis: This systematic review protocol follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines. Eligible study designs include randomised controlled trials (RCTs), cluster RCTs and quasi-experimental studies. Studies must target GPs, GP trainees or primary care physicians and report outcomes related to medication appropriateness, measured using validated tools (eg, Medication Appropriateness Index, Screening Tool of Older Person's Prescriptions/Screening Tool to Alert to Right Treatment). Secondary outcomes include hospital admissions, quality of life, prescribing behaviour, medication-related harms and cost-effectiveness. In addition to evaluating effectiveness, we will characterise heterogeneity in educational content and objectives, duration/intensity, theoretical or pedagogical underpinnings, delivery format, implementation fidelity and contextual factors. A comprehensive search will be conducted in MEDLINE, EMBASE, CINAHL and CENTRAL without language or date restrictions. The systematic review will follow PRISMA 2020 guidelines for data synthesis, and if meta-analysis is not feasible, Synthesis Without Meta-analysis reporting guidelines will be used. Ethics and dissemination: Findings will be disseminated through peer-reviewed publications and conference presentations. Results will inform the design of future educational strategies to optimise medication review and deprescribing practices in general practice and primary care, by identifying which approaches most effectively improve patient-centred outcomes and clarifying the role of educational components within complex, multicomponent interventions. Protocol registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025622443.