Brief Project Summary
Project Title: Engaging Patients to Promote Deprescribing
PI: Dr. Amy Linsky
Contact information: [email protected]
Study Type: Randomized Controlled Trial
Who, What, Where: Multisite trial to provide medication-specific educational brochures directly to veterans who may be deprescribing candidates for three cohorts taking potentially inappropriate medications (proton pump inhibitors, diabetes medications, and gabapentin), in advance of scheduled primary care visits.
Document List *
Objectives: One mechanism to reduce potentially inappropriate medications is through deprescribing, a de-implementation-based approach to thoughtfully discontinue a medication a patient is currently prescribed. Many interventions to overcome deprescribing barriers target the provider, who is already overburdened. In a single-site pilot study, we successfully engaged VA Primary Care patients to facilitate deprescribing of select potentially inappropriate medications. We now propose a multisite randomized controlled trial of engaging Veterans who may be deprescribing candidates.
Research Design: This study is a multisite quasi-experimental trial using a Hybrid Type I Effectiveness-Implementation design of providing EMPOWER brochures directly to approximately 6,800 Veterans who may be deprescribing candidates for three cohorts of Veterans taking potentially inappropriate medications (proton pump inhibitors, insulin or sulfonylureas, and gabapentin).
Methodology: We will mail brochures in advance of scheduled primary care visits. Our primary outcome will be the composite of deprescribing and de-escalation of target medications in the 12 months following brochure mailings, identified in pharmacy dispensing records of the Corporate Data Warehouse (Aim 1). Mail-based surveys sent after the scheduled primary care visit will assess patient engagement with the brochure and its impact on patient-provider communication (Aim 2). Qualitative data from up to 300 clinicians and staff will provide the foundation for future implementation strategies (Aim 3).
Clinical Implications: Reduction of low-value – and potentially harmful – care by deprescribing potentially inappropriate medications may reduce adverse drug event, increase patient satisfaction, and focus resources more efficiently.