How can we improve deprescribing communication among patients with dementia and multiple chronic conditions?
A qualitative study in primary care lends key insights.
Green AR, et al. Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: A Qualitative Study. J Gen Intern Med. 2020 Dec;35(12):3556-63. DOI: 10.1007/s11606-020-06063-y. Researchers from Johns Hopkins University and Kaiser Permanente Colorado conducted a qualitative study to determine patient, caregiver, and physician preferences for discussing deprescribing in primary care visits for patients experiencing dementia and multiple chronic conditions. Part of the Optimal Medication Management in Alzheimer’s Disease and Dementia (OptiMize) study, a trial designed to increase awareness of deprescribing in primary care settings, this study also focused on culturally competent messages as they relate to deprescribing. Semi-structured interviews with 17 patients, 16 caregivers, and 16 physicians revealed several key themes: trust between patients, caregivers, and physicians is critical for uptake of deprescribing, deprescribing should be framed positively as routine care, aligning dementia care goals and symptom management with deprescribing is essential, direct-to-patient informational materials
The US Deprescribing Research Network seeks applicants to form special interest groups (SIGs) in order to encourage networking and collaboration on specific projects. These member-led SIGs should: Be centered around a product (e.g., submitting symposia for presentation at a national meeting, a paper, etc.) Have a structure with a defined leader Be open to all and inclusive as possible in the product(s) (keeping criteria for authorship according to the ICJME in mind) Once a SIG is established, different products and leaders may evolve, but when starting it is important to have a clear idea of at least one initial product that the SIG will work together to develop and who will help lead these efforts. If you wish to apply to form a SIG, please see the instructions below. Application (Required, up to 250 words for each of 3 sections): Please describe: The deliverable product(s) and timeframe. How you will
Apply now to be part of USDeN’s next cohort of Junior Investigator Intensive Program participants! The program will create a cohort of emerging leaders who are committed to pursuing research training and collaborative opportunities related to deprescribing. Applications due February 1, 2021. Learn more
We are pleased to announce that Drs. Sean Hennessy and Allison Willis from the University of Pennsylvania will represent the 5th site for the Data Harmonization Working Group. The objective of this project is to develop and refine methods around creating, operationalizing, and implementing measures relevant to deprescribing studies across 5 institutions with different data systems. This will develop infrastructure for multi-site research, including preparing the study sites for future deprescribing trials, and inform creation of a “user’s guide” for using electronic health data for deprescribing research. The use of diverse sites and the user’s guide will lay a roadmap for other sites to participate in single- and/or multi-site research efforts in deprescribing that use electronic health data.
When it’s better to stop or decrease health care services and interventions: researchers bring validity and transparency to deintensification recommendations in primary care.
Kerr EA, et al. Identifying recommendations for stopping or scaling back unnecessary routine services in primary care. JAMA Intern Med. 2020;180(11):1500-1508. doi:10.1001/jamainternmed.2020.4001 A recent study published in JAMA Internal Medicine examined and validated recommendations for avoiding unnecessary and excessive health care services in primary care settings. Dr. Eve Kerr and team at the University of Michigan and the Ann Arbor VA point to the need to stop or scale back care when it is no longer indicated or when the benefits outweigh the harms. However, while many recommendations exist for increasing care, there is a dearth of practical, specific recommendations for deintensifying routine services. The study team identified 409 recommendations to stop or scale back care. The study team then consolidated and prioritized these guidelines and presented 37 recommendations to an expert panel to review using a modified Delphi approach. The expert panel reviewed evidence and suggested modifications to these
We are pleased to announce our 2020-2021 cohort of network grantees. Six projects, including 2 grant planning and 4 pilots are underway.
Aubert C, et al. Outcome Measures for Interventions to Reduce Inappropriate Chronic Drugs: A Narrative Review. J Am Geriatr Soc. 2020; doi: 10.1111/jgs.16697 A new review study examined outcome measures used in deprescribing interventions. Primary author Carole Aubert, MD out of the University of Michigan and team first identified relevant measures and then sought to categorize and synthesize these measures to inform future deprescribing study intervention design. Ninety-three studies were included in the review. The authors found that measures of deprescribing were inconsistent and infrequent, and most measures focused on outcomes related the specific drug studied. However, most studies used a measure of appropriateness such as drug cessation or dose reduction. Patient- and provider-reported outcomes such as experience and interaction were infrequently included, and only 26% of studies measured unintended consequences of deprescribing. In order for long-term success of deprescribing interventions, it is important to fill in the gaps by
The OPTIMISE Randomized Clinical Trial: Deprescribing Antihypertensive Medications in Adults Aged 80 and Older and its Effect on Blood Pressure
Sheppard J, et al. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients with Hypertension Aged 80 Years and Older. JAMA. 2020; doi: 10.1001/jama.2020.4871 Researchers from the University of Oxford conducted a randomized, noninferiority, unblinded study to determine whether deprescribing antihypertensive medications in older patients had an effect on systolic blood pressure (SBP) and adverse events when compared with usual care. In this trial “The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE),” older patients with polypharmacy and multimorbidity across 69 primary care sites in England were randomized to a medication reduction group or usual care. Five hundred and sixty-nine patients were randomized and 534 completed the study and were followed for 12 weeks. At the end of 12 weeks the intervention group demonstrated a mean increase of systolic blood pressure of 3.4 mm Hg (95% CI, 1.1-5.8 mm Hg) when compared
We are very pleased to announce our 2020-2021 cohort of Junior Investigator Intensive Awardees. The Junior Investigator Intensive program provides dedicated supports and research learning opportunities to help fellows, post-docs, and early-stage faculty succeed with their deprescribing-related research and advance their research careers. Our inaugural cohort awardees include 15 outstanding physician, pharmacist, and nurse investigators from the US, Canada, Australia, and Denmark. Nagham Ailabouni, BPharm, PhD Matthew Growdon, MD, MPH Juliessa Pavon, MD Mary Antonelli, PhD, RN Rasheeda Hall, MD, MBA, MHS Samuel Terman, MD Carole Aubert, MD Lisa McCarthy, PharmD, MSc Wade Thompson, PharmD, MSc Parag Goyal, MD, MSc Cara McDermott, PharmD, PhD Scott Vouri, PharmD, PhD Ariel Green, MD, MPH, PhD Joshua Niznik, PharmD, PhD Marnie Wilson, MD
The IMPACT Collaboratory released two new Requests for Applications (RFAs) for conducting pragmatic trials in persons with AD/ADRD on April 20: Request for Applications for 1-year ePCT pilot studies for up to $175,000 (direct costs) In response to the coronavirus disease (COVID-2019) outbreak, in this award cycle, the IMPACT Collaboratory will prioritize applications proposing pilot ePCTs of telemedicine, telehealth, and remote technologies interventions aimed at improving health outcomes for persons living with dementia and their caregivers. Applications for other types non-pharmacological interventions will also be considered. Mandatory letters of intent are due May 29, 2020 and will be reviewed on a rolling basis. Full proposal applications are by invitation only and are due September 4, 2020. For more information, pre-register now to participate in one of two optional webinars by clicking on your preferred date below: April 28, 2020 at 1:30 p.m. ET May 6, 2020 at 4:00 p.m. ET
COVID-19 response in post-acute and long-term care: Task force develops new guide to optimize medications.
A task force convened by the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy with assistance from the US Deprescribing Research Network has released a new implementation guide to optimize medications. Its goal is to improve resident-centered health and well-being by reducing use of unnecessary medications, simplifying medication management, and reducing opportunities for transmission of COVID-19 between residents and staff. By streamlining medication administration, these changes may also increase the time that staff have available for other direct care activities. See the full guide.
A new review article says it’s time to refine current adverse drug event adjudication methods to fit deprescribing studies.
Ross S, et al. Adverse Drug Events in Older Adults: Review of Adjudication Methods in Deprescribing Studies. J Am Geriatr Soc. 2020; doi: 10.1111/jgs.16382 A recent review article published in the Journal of the American Geriatrics Society examined adverse drug event (ADE) adjudication methods in deprescribing studies. Ross and colleagues of McGill University in Montreal, Canada reviewed 175 articles and found 10 different types of adjudication methods for identifying ADEs. Among existing methods, the Leape and Bates method and the Naranjo algorithm adapted for drug withdrawal have features that make them better suited than others for evaluating ADEs in studies of deprescribing. However, all methods had several weaknesses including being tailored to detect ADEs for a single medication and generally detecting adverse drug reactions instead of ADEs more broadly. Additionally, no method was developed specifically for deprescribing contexts. The authors emphasize the need for a standardized method that is (1)