Using Community Engagement to Initiate Conversations About Medication Management and Deprescribing in Primary Care Emily Galley, Barbara Farrell, James Conklin, Pam Howell, Lisa M. McCarthy, and Lalitha Raman-Wilms Abstract Polypharmacy, or the simultaneous use of multiple medications, represents a signifcant public health challenge—particularly among older adults, who are more likely to experience negative clinical outcomes attributable to adverse reactions to or interactions between their medications (Canadian Institute for Health Information, 2013). Improved medication management on the part of both patients and health care providers (HCPs) is needed to address the issues and consequences associated with polypharmacy, but conversations between patients and their HCPs about options for medication changes remain the exception. In a rural community near Ottawa, Ontario, a community-based participatory research (CBPR) approach aimed to support improved public awareness of and participation in medication management and deprescribing through educational events aimed at older adults. Tis paper describes the processes researchers used in collaboration with community members to discuss and address medication management in a locally relevant manner, details the results of these processes, and suggests how similar approaches may be employed to empower patients and communities to address issues of personal health care. Our research team has used a rigorous method to develop fve deprescribing guidelines intended to help health care providers (HCPs) decide when and how to reduce or stop medications that patients may no longer need or that cause more harm than beneft (Bjerre et al., 2018; Farrell, Black, et al., 2017; Farrell et al., 2016; Farrell, Pottie, et al., 2017; Pottie et al., 2018; Reeve et al., 2018). Although HCPs have widely accepted these guidelines in general, the recommendations remain challenging to implement in practice, and HCPs have told us that they would be more inclined to use them if patients initiated conversations about stopping their medications (Conklin et al., 2019). Tis is not common, however, so our team set out to work with members of the public to understand how to facilitate these deprescribing discussions. Te Deprescribing Initiatives Using Community Engagement (DICE) project was a co-constructed, community-level initiative to facilitate deprescribing conversations between members of the public and their HCPs. By formalizing a partnership between community members and our research team, we aimed to develop a sustainable strategy within the community, adapt it for broader use, and measure subsequent reach and adoption of the initiative. In this paper, we present our experience developing a local advisory group, summarize advisory group members’ perspectives on public knowledge and needs regarding polypharmacy and deprescribing, and outline the resulting educational intervention. Background Coexistence of multiple chronic health conditions, or multimorbidity, is common among older adults (Guerra et al., 2019; Salive, 2013). One consequence of multimorbidity is the simultaneous use of multiple medications, a phenomenon known broadly as polypharmacy. Polypharmacy is very common: An estimated two out of three Canadians over the age of 65 take at least fve prescription medications, and one out of four takes at least 10 (Canadian Institute for Health Information, 2018). Although it may be clinically appropriate for an individual to take multiple medications at once, polypharmacy can become problematic when the medications’ benefts are negated or outweighed by potential adverse efects (Masnoon et al., 2017). Te consequences of such polypharmacy—increased hospitalization and accompanying health care costs; increased risks of falls, drug interactions, and adverse drug events; and increased risk of cognitive decline—represent signifcant public health challenges (Duerden et al., 2013). Older adults are particularly vulnerable to negative outcomes associated with polypharmacy due both to its incidence among this demographic and to the