2025 – 2026
PRINCIPAL Investigator:
Michelle S. Keller, PhD, MPH – University of Southern California
Project Title:
Designing and Pilot Testing an Implementation Science-Based Intervention to Equip Inpatient Nurses for Deprescribing Education on Benzodiazepines and Z-Drugs
Literature Gap: Despite the well-documented risks of benzodiazepine receptor agonists (BZRAs) among older adults recovering from orthopedic procedures, these medications are frequently continued post-hospitalization due to prescribing inertia, care fragmentation, and a lack of structured deprescribing initiatives. While hospitalization represents a critical juncture for reassessing high-risk medications, current interventions have largely focused on outpatient settings, with limited research addressing deprescribing strategies during inpatient care. Notably, there is a paucity of interventions targeting front-line clinicians such as nurses, who are well-positioned to engage patients in deprescribing discussions but often lack the necessary training, support, and workflow integration. This proposal addresses these gaps by developing and evaluating a nurse-targeted, implementation science-based intervention designed to build capacity for deprescribing education during hospitalization.
Primary Study Aims:
Aim 1: Investigate systemic barriers and facilitators to engaging in medication-related conversations influencing inpatient nursing workflow using human factors methods.
Aim 2: Develop a nurse-targeted educational intervention focused on deprescribing benzodiazepines and Z-drugs for older adult patients hospitalized in the orthopedic unit.
Aim 3: Evaluate the feasibility, acceptability, and initial efficacy of the nurse-targeted intervention.
Study Design: This study employs a sequential mixed-methods design: Aim 1 uses human factors-based observational methods to identify systemic barriers to engaging in medication-related conversations at discharge, Aim 2 applies user-centered design to develop a nurse-targeted educational intervention, and Aim 3 conducts a pre-post feasibility study to evaluate the intervention’s acceptability, feasibility, and preliminary efficacy. Throughout all phases, a Community Advisory Board (CAB) composed of older adults, caregivers, and community leaders provides critical input to ensure the intervention aligns with patient and family needs and supports shared decision-making.
PRINCIPAL Investigator:
Thanh Phuong Pham Nguyen, PharmD, MBA, MSCE, BCPS
Co-PRINCIPAL Investigator:
Allison W. Willis, MD, MSCI – University of Pennsylvania Perelman School of Medicine
Project Title:
Evaluating the Effect of Deprescribing Antimuscarinic Overactive Bladder Medications on Cognitive Function and Quality of Life of Individuals with Parkinson Disease using a Pharmacist-led Series of N-of-1 Trials
Literature Gap: Older adults in the U.S. often face high medication burden due to multiple chronic conditions and prescribing cascades, leading to adverse health outcomes if treatments are not regularly reassessed and optimized. Deprescribing—the supervised reduction of unnecessary medications—remains underused, especially among individuals with Parkinson disease (PD), who are particularly vulnerable to the adverse effects of anticholinergic drugs such as antimuscarinics prescribed for overactive bladder (OAB), including cognitive impairment, gait instability, and increased mortality. Existing studies often lack the rigor to assess patient-specific risks and benefits, and current guidelines offer little personalized deprescribing guidance in this patient population. This study addresses a critical gap by applying N-of-1 trials to evaluate the necessity of OAB antimuscarinic use in older adults with PD, generating individualized, actionable evidence to inform safer prescribing practices.
Primary Study Aims: To evaluate the effects of deprescribing OAB antimuscarinics in individuals with PD on (i) cognitive function, (ii) autonomic symptom burden, and (iii) quality of life.
Study Design: This study will involve 20 N-of-1 trials in individuals with PD, using a crossover titration/reversal design (ABAB) with up to four 10-week periods. Each participant will alternate between being “ON” (A) and “OFF” (B) their previously prescribed OAB antimuscarinic. Dose reductions will follow a 25–50% tapering schedule every 1–2 weeks during the “OFF” period(s). Participants may complete 2 to 4 periods based on their need for additional information to make an informed decision about continuing the medication. The study will evaluate the impact of deprescribing antimuscarinics on cognitive function, autonomic symptoms, and quality of life. Outcomes will be compared between “ON” and “OFF” treatment periods using linear or generalized linear mixed models, accounting for treatment and period effects, as well as within-individual repeated measures.
PRINCIPAL Investigator:
Nicholas Schiltz, PhD – Case Western Reserve University
Project Title:
Deprescribing Potentially Inappropriate Medications in Age-Friendly Health Systems
Literature Gap: Despite growing awareness of the risks associated with potentially inappropriate medications (PIMs) in older adults, efforts to deprescribe have predominantly targeted traditional primary care or inpatient settings. Retail health clinics, such as CVS MinuteClinic, serve millions of older adults annually, yet they remain underexplored as venues for deprescribing interventions. Several years ago, the Age-Friendly Health Systems (AFHS) 4Ms framework, which includes screening for PIMs, was implemented across all MinuteClinic locations. Although nearly one-quarter of older adults in this population were identified as taking Beers Criteria© medications, only a small fraction of these cases resulted in medication changes or discontinuation. This highlights a critical gap in understanding how to effectively operationalize deprescribing and measure outcomes in the retail clinic setting. This project aims to address these gaps by combining a data-driven approach with stakeholder engagement to design a scalable, system-level deprescribing intervention specifically tailored to the retail clinic environment.
Primary Study Aims:
Aim 1: Identify the most frequently prescribed AGS Beers Criteria© medications and drug classes for patients aged 65 and older in a national network of retail health clinics.
Aim 2: Assess deprescribing outcomes following 4Ms care by comparing the discontinuation and dose changes of each AGS Beers Medication between patients aged 65 and older that received 4Ms care and those that did not.
Aim 3: Engage stakeholders to identify high-priority and actionable deprescribing targets, review evidence-based interventions, and assess implementation barriers and facilitators for a future system-wide intervention.
Study Design: This study will conduct a retrospective analysis of electronic health records (EHR) and linked Medicare claims data from MinuteClinic visits between 2021 and 2023. The analysis will focus on identifying the most frequent AGS Beers Criteria© medications prescribed and evaluating deprescribing outcomes following MinuteClinic visits. Patients will be compared based on their receipt of 4Ms care, using multivariable analyses to explore factors associated with deprescribing outcomes. Stakeholder engagement—including MinuteClinic leaders, pharmacists, educators, providers, and patient advisors—will guide the interpretation of findings and co-design of a future deprescribing intervention.
