Future implications for clinicians and policymakers in Ethiopia
There is a paucity of studies related to deprescribing prescribing in Ethiopia. In a limited-resource setting, inappropriate polypharmacy poses poor clinical outcomes, including ADEs and a high economic burden on the patients and the country at large. Polypharmacy is prevailing in Ethiopian patients, particularly in the older population and patients with cardiovascular disease (9, 32). This could be due partly because, as to the recent studies done in Ethiopia, inappropriate prescribing of medications has been pervasive in chronic patients such as patients with antithrombotic therapy and patients with cardiovascular disease (33, 34) .
Patients with inappropriate polypharmacy could also contribute to suboptimal medication adherence as patients get trouble with remembering to take multiple medications. The problem worsens when HCPs fail to make the deprescribing decision for inappropriate medications, particularly for older patients. Moreover, in a limited resource setting like Ethiopia, medication unavailability, and out-of-pocket expenditure are significant challenges in healthcare (35). The country cannot afford the underutilisation of medications due to non-adherence, and wastage of medications due to the inappropriate commission of medications. Deprescription could optimise medication use and reduce inappropriate polypharmacy, thereby improving medication adherence and utilising the available medications cost-effectively in resource-limited settings. Stakeholders such as the Ethiopian Ministry of Health and professional associations should consider deprescription practice to integrate it into the clinical practice. They could also take the lead and organise to develop therapy-specific guidelines for deprescribing algorithm and providing continuous professional development to HCPs.