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Deintensifying diabetes medications: Beliefs and misconceptions among older adults

Pilla SJ, Meza KA, Schoenborn NL, Boyd CM, Maruthur NM, Chander G. A Qualitative Study of Perspectives of Older Adults on Deintensifying Diabetes Medications [published online ahead of print, 2022 Sep 29]. J Gen Intern Med. 2022;10.1007/s11606-022-07828-3. doi:10.1007/s11606-022-07828-3 While previous studies have examined the patient perspective on deprescribing, few have explored this topic in relation to diabetes medications. Guidelines recommend deintensification of diabetes medications for older adults with type 2 diabetes who are below glycemic target where it can reduce polypharmacy or the risk of adverse drug effects. In practice, however, diabetes medications are rarely stopped or reduced regardless of glycemic control or health status. In hopes of optimizing deintensification, researchers at Johns Hopkins set out to understand the patient perspective on stopping or reducing diabetes medications. They conducted a qualitative study using individual semi-structured interviews of 24 older adults with medication-treated type 2 diabetes and good glycemic control. Interviewers

Gabapentin as a substitute for opioids: Is the solution creating new problems?

Bongiovanni T, Gan S, Finlayson E, et al. Prolonged use of newly prescribed gabapentin after surgery [published online ahead of print, 2022 Aug 24]. J Am Geriatr Soc. 2022;10.1111/jgs.18005. doi:10.1111/jgs.18005 Postoperative pain management has changed significantly in the last decade. Surgeons have attempted to decrease opioid prescribing by using non-opioid “multimodal” pain regimens, such as gabapentinoids (gabapentin and pregablin). While gabapentinoids are associated with reduced postoperative pain and opioid consumption, they are still included in the AGS Beers Criteria list as potentially inappropriate medications (PIMs) for older adults in certain contexts. In addition, closer attention must be paid to the proper discontinuation of gabapentinoids when they are no longer needed for post-operative pain control. Prolonged use of gabapentinoids carries its own unique risks, from altered mental status to other adverse events and hospitalizations. Researchers from UCSF and Yale investigated the predictors of prolonged gabapentin use through a retrospective cohort study

The Tool to Reduce Inappropriate Medications (TRIM): Can a clinical decision support tool promote deprescribing among primary care clinicians?

Mecca MC, Zenoni M, Fried TR. Primary care clinicians’ use of deprescribing recommendations: A mixed-methods study. Patient Educ Couns. 2022;105(8):2715-2720. doi:10.1016/j.pec.2022.04.013 The Tool to Reduce Inappropriate Medications (TRIM) provides individualized reports on patient medications, including medication reconciliation errors and potentially inappropriate medications (PIMs). A recent study published in Patient Education and Counseling explored the impact of TRIM reports on primary care clinicians’ medication communication and deprescribing practices. While clinicians who received TRIM reports performed more robust medication reconciliation and were more likely to discuss treatment intensity, medication non-adherence, and poor cognition, these clinicians were not more likely to deprescribe or deintensify medications. Deintensification usually happened in response to a patient’s adverse event rather than in response to TRIM recommendations. In addition, medication reconciliation elements of the TRIM report led to more medication discussion than parts of the report that delineated potentially inappropriate medications. Despite increased discussion among clinicians and patients

Can N-of-1 trials inform deprescribing practices? Dr. Parag Goyal weighs in

Goyal P, Safford M, Hilmer SN, et al. N-of-1 Trials to Facilitate Evidence-Based Deprescribing: Rationale and Case Study [published online ahead of print, 2022 Jun 15]. Br J Clin Pharmacol. 2022;10.1111/bcp.15442. doi:10.1111/bcp.15442 Junior Investigator Intensive scholar Parag Goyal and a team of researchers recently published a narrative review on deprescribing-N-of-1 trials. N-of-1 trials compare treatment effects in an individual patient by following the same patient over multiple time periods, a clinical trial subtype known as ‘multiple-period crossover design experiments.’ While N-of-1 trials are typically used to compare medication class or dosage, the therapeutic precision associated with this type of trial is also well-suited to deprescribing research. Deprescribing-N-of-1 trials provide evidence on the impact of continuing or stopping treatment in an individual patient. Individual-level evidence may allay patient and physician concerns about discontinuing medication and involve the patient in the clinical decision-making process. Additionally, N-of-1 trials may evade the time constraints

Survey finds that Willingness to Deprescribe is Linked to Health Outcome Priorities

Green AR, Aschmann H, Boyd CM, Schoenborn N. Association between willingness to deprescribe and health outcome priorities among U.S. older adults: Results of a national survey [published online ahead of print, 2022 Jun 6]. J Am Geriatr Soc. 2022;10.1111/jgs.17917. doi:10.1111/jgs.17917 A team led by Dr. Ariel Green, who received a pilot award from the US Deprescribing Research Network, recently published a clinical investigation in JAGS on the association between willingness to deprescribe and health outcome priorities among older adults. A 2020 cross-sectional survey of older adults’ responses to two scenarios informed this study: Preventive medicine scenario: Respondents are asked about their willingness to deprescribe a statin being used for primary prevention that may cause side effects such as muscle pain or weakness, nausea, constipation, diarrhea, and drug interactions. Symptom-relief medicine scenario: Respondents are asked about their willingness to deprescribe a sedative-hypnotic being used for insomnia that may cause side effects

All about Outcomes: USDeN Panel Weighs in on Defining, Selecting, and Applying Deprescribing Intervention Outcomes

Bayliss, EA, Albers, K, Gleason, K, et al. Recommendations for outcome measurement for deprescribing intervention studies. J Am Geriatr Soc. 2022; 1- 11. doi:10.1111/jgs.17894 The US Deprescribing Research Network’s very own Measures Workgroup recently published recommendations for selecting and using outcomes for deprescribing interventions in the Journal of the American Geriatrics Society. Authors point to discrepancies in outcome definitions as a barrier to high quality evidence on the impact of deprescribing. Inconsistent evidence slows the translation of findings into clinical practice. Through a scoping review of the deprescribing literature, authors identified common outcome measures from 107 deprescribing studies. An expert panel, 12 members from the workgroup with expertise in deprescribing research as well as primary care, geriatrics, pharmacology, and implementation science, convened nine times to discuss outcome measures in the literature. The panel had three goals: To identify common deprescribing measures and outcome definitions To prioritize outcome categories for future

USDeN Call for Pilot Studies Preparatory to Large Clinical Trials

Complementary and Integrative Health Interventions to Support Deprescribing of Benzodiazepine Receptor Agonists in Older Adults The US Deprescribing Research Network (USDeN) will soon be seeking applications for large pilot studies that test complementary and integrative health approaches to support deprescribing of benzodiazepine receptor agonists in older adults. The goal of this program is to support pilot studies that will test study procedures, refine interventions, assess feasibility, and other such activities such that by the end of the one-year pilot study the investigators will be well-positioned to apply for a large grant to conduct a definitive clinical trial of the interventions. Pilot studies will be awarded with a budget of up to approximately $160,000 over one year. For more information, visit our Grants Opportunity page, and reach out to [email protected]

Describing deprescribing: How do GPs discuss deprescribing topics with their patients, and how in-depth do they go?

Thompson W, Jarbøl D, Nielsen JB, Haastrup P, Pedersen LB. GP preferences for discussing statin deprescribing: a discrete choice experiment. Fam Pract. 2022;39(1):26-31. doi:10.1093/fampra/cmab075 Although there is ample evidence on the benefits of deprescribing for older patients, providers’ deprescribing-related communication preferences are less understood. Given that clinicians often have the greatest influence on patients’ deprescribing decisions, it is crucial for researchers to understand clinician preferences. Former USDeN Junior Investigator Intensive (JII) scholar Dr. Wade Thompson and his team at the University of Southern Denmark narrowed in on the preferences of general practitioners (GPs) in Denmark, who are responsible for the majority of prescribing for Danish patients. The study team conducted a discrete choice experiment (DCE), which required participants to choose between alternative discussions with hypothetical patients. The DCE involved statin treatment and assessed GPs’ preferred discussion length (‘no discussion,’ ‘brief discussion,’ or ‘detailed discussion’) for four different topics: goals of

New Cohort of Junior Investigators Selected!

We are thrilled to announce our 2022-2023 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. This years cohort awardees include 13 outstanding physician, pharmacist, and PhD investigators from the US, Australia, Ethiopia, and Switzerland. Tasce Bongiovanni, MD, MPPUniversity of California, San Francisco Martin Casey, MD, MPHUniversity of North Carolina at Chapel Hill,School of Medicine Maria Garcia, MD, MPH, MASUniversity of California, San Francisco Kaley Hayes, PharmD, PhDBrown University Daniel Hoyle, PhD, BPharm (Hons)University of Tasmania Katharina Tabea Jungo, PhD, MScInstitute of Primary Health Care (BIHAM),University of Bern Jiha Lee, MD, MHSUniversity of Michigan Veena Manja, MBBS, PhD, MScStanford University Thanh Phuong Pham Nguyen, PharmD, MBA, MSCEUniversity of Pennsylvania,Perelman School of Medicine Henok Tegegn, BPharm, MScUniversity of New England, Australia Jinjiao Wang, PhD, RNUniversity

How can we apply pharmacoepidemiology methods to deprescribing research questions?

Moriarty F, Thompson W, Boland F. Methods for evaluating the benefit and harms of deprescribing in observational research using routinely collected data. Res Social Adm Pharm. 2022;18(2):2269-2275. doi:10.1016/j.sapharm.2021.05.007 Recent advances in pharmacoepidemiology have allowed researchers to apply randomized controlled trial (RCT) principles to observational data. These advances have resulted in better estimates of medication harms and benefits using existing datasets. While these methods are more frequently applied to prescribing studies, they are rarely applied to deprescribing research. A recent study published in Research in Social and Administrative Pharmacy explored the applications of pharmacoepidemiology and causal inference methods to deprescribing research. Authors Frank Moriarty, Wade Thompson, and Fiona Boland framed their research using case studies of benzodiazepines and low-dose aspirin, both of which are often targeted for deprescribing. They provide an overview of research considerations when applying pharmacoepidemiological methods to deprescribing research using observational datasets. Their findings are presented in three

The MedSafer Study-Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial

McDonald EG, Wu PE, Rashidi B, et al. The MedSafer Study-Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial [published online ahead of print, 2022 Jan 18]. JAMA Intern Med. 2022;10.1001/jamainternmed.2021.7429. doi:10.1001/jamainternmed.2021.7429 A team of researchers investigated the impact of MedSafer, an electronic deprescribing tool based on electronic health record data and expert consensus. MedSafer is a personalized tool designed to identify potentially inappropriate medications and guide health care professionals through appropriate deprescription practices. Researchers conducted a cluster randomized clinical trial at 11 Canadian acute care hospitals, assessing patients 65 and older who were taking at least 5 medications. Organized into 3 clusters, 5,698 participants received care either during a control phase or an intervention phase. The control phase consisted of usual care (medication reconciliation), while the intervention phase provided individualized deprescribing reports to the patient’s care team, community pharmacy, and usual physician. The main

Deprescribing Lessons from a Nonessential Medication Hold Policy in US Nursing Homes

 McConeghy, K. W., Cinque, M., White, E. M., Feifer, R. A., Blackman, C., Mor, V., Gravenstein, S., & Zullo, A. R. (2021). Lessons for deprescribing from a nonessential medication hold policy in US nursing homes. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.17512   The COVID-19 pandemic caused nursing homes to rapidly adapt to new care processes. When a large nursing home chain implemented a policy to temporarily hold potentially unnecessary medications, a unique opportunity was presented to deprescribing researchers. Dr. Kevin McConeghy and colleagues conducted a retrospective cohort study using electronic health record data to describe rates of held and discontinued medications as a result of the temporary policy.   By the end of the hold policy, more than half (54%) of nonessential medications were permanently discontinued. Multivitamins were most likely to be held, followed by histamine-2 receptor antagonists, antihistamines, and statins. Additionally, over 50% of the variability in whether

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