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Green AR, Quiles R, Daddato AE, Merrey J, Weffald L, Gleason K, Xue QL, Swarthout M, Feeser S, Boyd CM, Wolff JL, Blinka MD, Libby AM, Boxer RS. Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study. J Am Geriatr Soc. 2024 Mar 15. doi: 10.1111/jgs.18867. Epub ahead of print. PMID: 38488757. This pilot study, conducted from May 2021 to 2022, assessed the feasibility and effectiveness of a pharmacist-led telehealth intervention called ALIGN. This intervention aimed to optimize medication management for people living with dementia (PLWD) who are dealing with polypharmacy, specifically targeting those on seven or more medications with a care partner involved. The study’s primary goals are to align medication regimens with the patient and care partner’s goals and to reduce medication burden and complexity.  The study utilized a two-arm randomized design involving PLWD aged 65 or older across primary care clinics

Singh S, Cocoros NM, Li X, Mazor KM, Antonelli MT, Parlett L, Paullin M, Harkins TP, Zhou Y, Rochon PA, Platt R, Dashevsky I, Massino C, Saphirak C, Crawford SL, Gurwitz JH. Developing a PRogram to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in the Elderly with Alzheimer’s Disease (D-PRESCRIBE-AD): Trial protocol and rationale of an open-label pragmatic, prospective randomized controlled trial. PLoS One. 2024 Feb 12;19(2):e0297562. doi: 10.1371/journal.pone.0297562. PMID: 38346025; PMCID: PMC10861034. The D-PRESCRIBE-AD trial aims to evaluate the effectiveness of educational outreach by health plans in reducing inappropriate medication use among elderly individuals with Alzheimer’s disease or related dementias (AD/ADRD). These patients are particularly vulnerable to the risks associated with sedative/hypnotics, antipsychotics, and strong anticholinergic agents, which are medications that are deemed potentially inappropriate according to the AGS Beers criteria. The trial seeks to promote discussions on deprescribing to lessen the negative impacts of these

Jungo KT, Weir KR, Cateau D, Streit S. Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial. BMJ Open. 2024 Jan 10;14(1):e075325. doi: 10.1136/bmjopen-2023-075325. PMID: 38199626; PMCID: PMC10806786. The study aimed to explore the link between older patients’ willingness to have medications deprescribed and the outcomes related to medication changes, medication appropriateness, and the adoption of prescribing recommendations from the electronic decision support system in the OPTICA trial. It was conducted as a longitudinal sub-study within the OPTICA trial across various Swiss primary care settings involving 43 general practitioner practices. This post-hoc sub-study of the OPTICA trial recruited 323 patients aged 65 or older with multiple chronic conditions and polypharmacy. Participants were randomly assigned to either an intervention or control group, with the intervention group undergoing a structured medication review using an electronic clinical decision support system. The study assessed patients’ willingness

Chae S, Lee E, Lindenberg J, Shen K, Anderson TS. Evaluation of a benzodiazepine deprescribing quality improvement initiative for older adults in primary care. J Am Geriatr Soc. 2023 Dec 26. doi: 10.1111/jgs.18728. Epub ahead of print. PMID: 38147454. This study, conducted at a large US academic medical center, aimed to evaluate the impact of a low-intensity benzodiazepine deprescribing initiative in primary care involving individuals aged 65 or older. The primary objective was to evaluate patient and clinician engagement challenges within this initiative, highlighting the importance of understanding these challenges for future interventions aimed at encouraging proactive deprescribing conversations. The low-intensity benzodiazepine deprescribing quality improvement program was implemented in a large academic primary care clinic in Massachusetts between February and April 2022. The target population comprised adults aged 65 and older with at least one prescription for benzodiazepines from primary care physicians (PCPs) in the previous year, excluding those with

Weir KR, Shang J, Choi J, Rana R, Vordenberg SE. Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation. JAMA Netw Open. 2023 Oct 2;6(10):e2337281. doi: 10.1001/jamanetworkopen.2023.37281. PMID: 37819657; PMCID: PMC10568363. This investigation aimed to understand why older adults disagree with deprescribing recommendations from primary care physicians in hypothetical scenarios. The study cohort consisted of individuals aged 65 or older from the United Kingdom, the United States, Australia, and the Netherlands. The study utilized an online survey that described a hypothetical vignette about Mrs. EF, a 76-year-old woman, and her primary care physician’s deprescribing recommendation to stop either lansoprazole or simvastatin. Using a 6-point Likert scale, participants rated their agreement with the physician’s recommendation to stop the medication, and those strongly disagreeing or disagreeing were asked to provide free text comments explaining their disagreement. The study performed a content analysis of these free-text responses. The analyses involved 899

Norton JD, Zeng C, Bayliss EA, Shetterly SM, Williams N, Reeve E, Wynia MK, Green AR, Drace ML, Gleason KS, Sheehan OC, Boyd CM. Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia. JAMA Netw Open. 2023 Oct 2;6(10):e2336728. Deprescribing is challenging. While a number of qualitative studies have explored clinician barriers to deprescribing, relatively little work has been done to quantify clinician’s perceptions of the relative importance of these barriers. The Norton et al. study, conducted from January 15 to December 31, 2021, was a cross-sectional national survey aiming to investigate how primary care physicians prioritize ethical and pragmatic factors when making deprescribing decisions for older adults (aged 65+) with moderate dementia. The survey sought to identify the biggest and smallest barriers to deprescribing in situations where ethical dilemmas may arise by using best-worst scaling methods to rank nine influencing factors. In doing so, the study

Pitts SI, Olson S, Yanek LR, Wang N, Woodroof T, Chen AR. Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation. JAMA Intern Med. 2023;183(10):1120–1126. doi:10.1001/jamainternmed.2023.4192 The primary objective of this study was to evaluate the impact of implementing e-prescription cancellation messaging (CancelRx) on medication dispensing after e-prescription discontinuation within the electronic health record (EHR).  Pitts et al. conducted a case series study with an interrupted time series analysis design at an urban academic medical center, spanning from one year before CancelRx implementation on January 15, 2018, to approximately a year after, concluding on December 7, 2019. The study also aimed to investigate variations in medication dispensing patterns based on factors such as pharmacy and medication class. The study included patients who received at least one e-prescription in ambulatory care within a two-year period surrounding CancelRx’s January 15, 2019 implementation. The analysis covered pre-post comparisons, variations by pharmacy and medication class using EHR

Herrinton LJ, Lo K, Alavi M, Alexeeff SE, Butler KM, Chang C, Chang CC, Chu VL, Krishnaswami A, Deguzman LH, Prausnitz S, Mason MD, Draves M. Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2023 Jul 3;6(7):e2322505. doi: 10.1001/jamanetworkopen.2023.22505. PMID: 37428504; PMCID: PMC10334220. The study by Herrinton et al. was a randomized clinical trial conducted from October 2020 to July 2022 within the Kaiser Permanente Northern California healthcare system. Its primary goal was to assess the effectiveness and safety of a bundled hyperpolypharmacy deprescribing intervention among older adults (76 years and older) using ten or more prescription medications. The study’s primary objectives were to measure changes in the number of medications prescribed and the occurrence of geriatric syndrome components reflecting adverse drug effects. Secondary endpoints included healthcare utilization and adverse drug withdrawal effects. The study sought to determine if

Hall RK, Rutledge J, Lucas A, Liu CK, St Clair Russell J, St Peter W, Fish LJ, Colón-Emeric C. Stakeholder Perspectives on Factors Related to Deprescribing Potentially Inappropriate Medications in Older Adults Receiving Dialysis. Clin J Am Soc Nephrol. 2023 Jul 27. doi: 10.2215/CJN.0000000000000229. Epub ahead of print. PMID: 37499693. The study by Hall et al. was an observational qualitative study conducted in Durham, North Carolina, involving semi-structured interviews and focus groups with key stakeholders. It aimed to understand the perspectives of clinicians and patients regarding deprescribing potentially inappropriate medications in older adults receiving dialysis. The study’s primary objective was to identify factors affecting the integration of deprescribing in dialysis clinics, informing the development of a targeted program. It addressed obstacles including system-level issues, unclear co-management, knowledge gaps, and patient preferences to improve medication management in this healthcare context. The study encompassed 76 participants, with 53 clinicians and 23 patients,

Deardorff WJ, Jing B, Growdon ME, Yaffe K, Boscardin WJ, Boockvar KS, Steinman MA. Medication misuse and overuse in community-dwelling persons with dementia. J Am Geriatr Soc. 2023 Jun 5. doi: 10.1111/jgs.18463. Epub ahead of print. PMID: 37272899. The study by Deardorff et al. investigated medication misuse and overuse within the community-dwelling older adult population affected by dementia. Using Health and Retirement Study (HRS) data from 2008 to 2018, a nationally representative survey of U.S. adults, the main goal was to characterize potentially problematic medication use, covering diabetes and hypertension overtreatment, cognition-impairing drugs, and medications from consensus criteria (2019 Beers and STOPP Version 2). By comparing medication trends between those with and without dementia, it seeks to provide insights into problematic prescribing, highlighting areas for interventions and deprescribing to enhance care quality for individuals with dementia. The study cohort comprised individuals aged 66 years and above, identified as having dementia