Boston—Mailing patient-directed educational materials prior to primary care visits can be an effective, low-tech intervention to promote deprescribing of potentially low-value and high-risk medications, according to a new study.

“Incorporating patient-directed educational strategies can increase the clinical uptake of deprescribing,” wrote the authors of the study led by the Veterans Affairs (VA) Boston Health Care System and Harvard Medical School. “With healthcare increasingly prioritizing patient-centered delivery models, this intervention can be easily disseminated to have timely impact on quality, safety, and satisfaction among patients, clinicians, and healthcare systems.”

The study published in the Journal of the American Medical Association Internal Medicine suggests that patient-directed educational materials “are a promising implementation strategy to expand deprescribing reach and adoption, but little is known about the impact across medication groups with potentially different perceived risks.”

The study team sought to examine the impact of a patient-directed education intervention on clinician deprescribing of potentially low-benefit (proton pump inhibitors in this case) or high-risk medications (high-dose gabapentin and diabetes agents with hypoglycemia risks) for purposes of the study.

The pragmatic multisite, nonrandomized clinical trial took place at three geographically distinct U.S. VA medical centers from April 2021 to October 2022.

The primary intervention component was a medication-specific brochure, mailed during the intervention time frame to more than 2,500 eligible patients 2 to 3 weeks prior to upcoming primary care appointments, was the primary intervention component. Patients seen by the same one to three primary care physicians (PCPs) at the same sites 1 year prior to the study intervention served as controls, also numbering about 2,500.

The primary binary outcome variable was defined as deprescribing 6 months after the intervention. That was based on complete cessation or any dose reduction of the target medication using VA pharmacy dispensing data.

The results indicated that the overall rate of deprescribing among the intervention cohort (n = 2539) was 29.5%, compared with 25.8% among the controls (n = 2532).

In an unadjusted model, the intervention cohort was found to be significantly more likely to be involved in deprescribing (odds ratio [OR], 1.17; 95% CI, 1.03-1.33; P = .02). In a multivariable logistic regression model nesting patients within PCPs within sites and controlling for patient and PCP characteristics, the odds of deprescribing in the intervention cohort were 1.21 times that of the control cohort (95% CI, 1.05-1.38; P = .008).

The authors reported that deprescribing prevalence between the intervention and control cohorts—proton pump inhibitors: 29.4% versus 25.4%; gabapentin: 40.2% versus 36.2%; hypoglycemia risk: 27.3% versus 25.1%—showed no statistical difference by medication group.

“This nonrandomized clinical trial found that patient-directed educational materials provided prior to scheduled primary care appointments can effectively promote deprescribing for potentially low-benefit and high-risk medication groups,” the researchers pointed out.

Background information in the article advised, “Inappropriate medication use and polypharmacy are common and costly problems plaguing patients, clinicians, and healthcare systems. National campaigns, such as the American Board of Internal Medicine’s Choosing Wisely campaign, attempt to decrease inappropriate medication use and polypharmacy, but medication safety issues continue to be widespread. Nearly 1 in 5 (17.1%) U.S. adults take 5 or more medications, a commonly accepted threshold for polypharmacy, escalating to 50% among older adults with chronic conditions.”

The authors added that, while deprescribing has the potential to reduce low-value medication use, it is not routinely adopted into clinical practice, noting, “Indeed, medication management can be a highly complex interplay between patients, clinicians, and the healthcare system, making partnering with patients integral to deprescribing.”

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