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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

US Emergency Department Visits Attributed to Medication Harms

Budnitz DS, Shehab N, Lovegrove MC, Geller AI, Lind JN, Pollock DA. US Emergency Department Visits Attributed to Medication Harms, 2017-2019. JAMA. 2021;326(13):1299–1309. doi:10.1001/jama.2021.13844   Medication risk assessment should account for both therapeutic use as well as nontherapeutic use. Therapeutic use refers to medications taken as prescribed, while nontherapeutic use refers to unsupervised medication use, medication misuse and abuse, and self-harm. To account for both types of use, Dr. Daniel Budnitz and CDC colleagues set out to describe the nature of emergency department (ED) visits for medication harms in the US between 2017-2019. The authors investigated both medication type and intent of use associated with ED visits, as well as differences by patient age group.   Budnitz and colleagues used cross-sectional, nationally representative public health surveillance data to identify adverse events attributed to one or more medications. The rate of ED visits for medication harms was highest among patients aged 65 and

Identifying Real-World Patterns of Bisphosphonate Deprescribing in Nursing Home Residents with Dementia

Niznik, J.D., Aspinall, S.L., Hanson, L.C. et al. Patterns of Oral Bisphosphonate Deprescribing in Older Nursing Home Residents with Dementia. Osteoporos Int. Sep 2021. https://doi.org/10.1007/s00198-021-06141-9 Dr. Niznik and colleagues determines the incidence of deprescribing bisphosphonates among nursing home residents with dementia, and identified factors associated with deprescribing bisphosphonates. Dr. Niznik and team point to the need of addressing the gaps in knowledge about real-world patterns of bisphosphonate deprescribing in nursing home residents with dementia. Dr. Niznik and colleagues used innovative methods to find instances of deprescribing, and see what predicted deprescribing for a nationally representative sample of older adults in nursing homes. Using data from older adults who are in nursing homes (Minimum Data Set), Medicare claims, Nursing Home Compare and Medicare Part D data and a deprescribing definition of a 90-day gap in medication supply, the 180-day cumulative incidence of deprescribing bisphosphonates was 14.8%.   Factors associated with increased likelihood

How Can We Apply a Sex and Gender Lens to Deprescribing Research and Clinical Practice?

Rochon, PA et al. Polypharmacy, Inappropriate Prescribing, and Deprescribing in Older People: Through a Sex and Gender Lens. Lancet Healthy Longev. 2021 May; 2(5) e290-300. DOI: https://doi.org/10.1016/S2666-7568(21)00054-4 Appropriate prescribing and medication optimization is important as older adults age, but little attention has been paid to the sex and gender differences of prescribing in older age. In this review article, primary author Dr. Paula Rochon and team assess optimal prescribing practices via tools and frameworks for inappropriate prescribing in older adults with an emphasis on these differences. The authors found that although there are a number of frameworks, tools, and processes related to appropriate prescribing, none of them were developed with sex and gender differences in mind. Several of them, however, have been used by researchers to evaluate these differences. For example, the Beers Criteria have been studied by investigators internationally who often find that women are more likely to be

New Cohort of Junior Investigators Selected!

We are thrilled to announce our 2021-2022 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, Denmark, and Ireland. Tim Anderson, MD,Harvard Medical School &Beth Israel Deaconess Medical Center Tesfahun Eshetie, PhD,University of Washington Anna Hung, PharmD, PhD,Duke University Michelle Keller, PhD,Cedars-Sinai Medical Center Carina Lundby, MScPharm, PhD,Odense University Hospital &University of South Denmark Hemalkumar Mehta, PhD,Johns Hopkins University Frank Moriarty, MPharm, PhD,Royal College of Surgeons in Ireland Gregory Ouellet, MD,Yale School of Medicine Scott Pilla, MD,Johns Hopkins University Thomas Radomski, MD,University of Pittsburgh Manvi Sharma, PhD,University of Mississippi Jennifer Stoll, PhD,University at Buffalo School of Family Medicine Sarah Vordenberg, PharmD,University of Michigan

Annual Meeting Registration Now Open!

The US Deprescribing Research Network’s 2nd Virtual Annual Meeting is now open for registration. The meeting with take place virtually on Thursday, May 27, 2021 from 11am-2pm ET. We hope you can join us! Click for agenda and registration

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