Deprescribing research requires many types of methods, ranging from selecting valid and meaningful outcome measures to identifying optimal intervention strategies to supporting effective recruitment and retention of older adults for clinical trials of deprescribing. Below is an annotated list of resources that may be useful to investigators seeking ideas, best practices, and inspiration for their own research. The field of deprescribing is sufficiently broad that it is impossible to generate a truly comprehensive list, and in many cases, there is not well-established best practice guidance for a specific methodologic topic. Thus, this list of resources is best viewed as a sample of manuscripts and other materials that can help inspire ideas and provide guidance about useful avenues to explore. Investigators should supplement this list by seeking out additional materials and guidance about methodologies and topics of special interest to them.
In addition to this page, we strongly encourage people to review research resources available on other parts of the USDeN website and elsewhere, including:
- Resources for stakeholder engagement (https://deprescribingresearch.org/network-activities/engaging-stakeholders-in-research/)
- Repository of IRB and DSMB materials for deprescribing studies (https://deprescribingresearch.org/network-activities/data-and-resources/irb-dsmp-repository/)
- Search strategy guidance for identifying literature on deprescribing (https://deprescribingresearch.org/deprescribing-literature-search-strategy/)
- Best-practice recommendations for selection of outcome measures for deprescribing studies (https://pubmed.ncbi.nlm.nih.gov/35648465/)
- Best-practice recommendations for measuring deprescribing using electronic health record data (https://www.youtube.com/watch?v=T2splq3ATJ4)
- Repository of research measures relevant to older adults (OAIC Geriatric Research Instrument Library) (https://www.peppercenter.org/public/gril.cfm)
- Repository of statistical code and algorithms for aging science (OAIC Geriatric Research Algorithms & Statistical Programs [GRASP]) (https://www.peppercenter.org/public/grasp.cfm)
- Selection of Outcome Measures
- Measurement of Deprescribing, Medication Use, and Treatment Intensity Using Electronic Health Records and Claims Data
- Measuring Adverse Drug Events and Adverse Drug Withdrawal Events in Deprescribing Studies
- Measures of Patient/, Caregiver, and Clinician Attitudes and Decision-Making Toward Deprescribing
- General Resources for Studies of Deprescribing Interventions
- Conceptual Frameworks of Deprescribing
- Behavior Change and Implementation Science Concepts and Strategies for Deprescribing Studies
- N-of-1 Deprescribing Trials
- Recruitment and Retention for Deprescribing Studies
- General Resources for Observational Studies of Deprescribing
- Perspectives on the Field
- Defining Deprescribing
- Reporting Results of Deprescribing Trials
- Deprescribing Involving Historicallly Marginalized Communitites
- Intersection of Aging, End-of-Life Care, and Deprescribing
- Ethics of Deprescribing
- Value Assessment in Deprescribing
Measurement
SELECTION OF OUTCOME MEASURES
A variety of outcome measures may be used for studies of deprescribing. These resources summarize measures that investigators have used and provide best-practice guidance for measure selection.
- USDeN-sponsored consensus project offering best practice recommendations for selecting outcome measures for deprescribing studies.
- Review of measures used in deprescribing studies.
- Commentary on potential uses of the win-ratio method for deprescribing trial outcomes
MEASUREMENT OF DEPRESCRIBING, MEDICATION USE, AND TREATMENT INTENSITY USING ELECTRONIC HEALTH RECORDS AND CLAIMS DATA
Measuring deprescribing using electronic health record and health care claims data is challenging. These resources describe methods and learnings about these measurement issues and related constructs.
- Validation study of claims-based measures of deprescribing using US Medicare data.
Measuring Key Deprescribing Variables from Electronic Health Records: Challenges and Recommendations
- USDeN-sponsored project developing methods and best practices for measuring deprescribing of benzodiazepines using electronic health record and claims data. The above link is a presentation on this topic from the USDeN 2023 annual meeting; a paper describing these findings is forthcoming.
- Study of bisphosphonate deprescribing in nursing homes that includes a useful exploration of the test characteristics of different methods for measuring deprescribing using Medicare Part D data.
- Review of methods defining duration of medication prescriptions using secondary data sources.
- Study on medication use in dementia which offers a method for defining period-prevalent medication use based on Medicare Part D claims.
- Methodologic study evaluating and validating different methods for determining prevalent medication use using pharmacy dispensing data.
- Systematic review of methods for determining cross-sectional active medications using pharmacy databases.
- Small study evaluating accuracy of the medication list in EHR data across several sites.
- Expert review and critique of composite dosage intensity measures for CNS and antihypertensive medications.
HEDIS measure: Deprescribing of Benzodiazepines in Older Adults
- HEDIS measure that defines deprescribing AND dose reduction of benzodiazepines in older adults
- An USDeN webinar on this topic
- Associated slide deck
MEASURING ADVERSE DRUG EVENTS AND ADVERSE DRUG WITHDRAWAL EVENTS IN DEPRESCRIBING STUDIES
Measurement of adverse drug events (ADEs) and adverse drug withdrawal events (ADWEs) is often important for outcome assessment in trials of deprescribing interventions. While there is an extensive literature on measuring ADEs, relatively little work has been done on measuring ADWEs. There is ongoing research on this topic through the GEODES study (https://reporter.nih.gov/search/wq5DGDOTCkWWqVgSE361DA/project-details/10096865) and other efforts.
- Review of methods and issues for ascribing causality between deprescribing and future clinical events, including adverse drug events and adverse drug withdrawal events
- Review of adjudication methods for assessing ADWEs in studies of deprescribing.
- Thematic review of ADWEs in deprescribing trials
- Summary of clinical considerations for minimizing risk of ADWEs for commonly-deprescribed medications.
- Exemplar study of using claims data to evaluate high-level ADWEs associated with deintensification of diabetes medications in nursing home residents.
- Exemplar study using chart review methods to identify ADWEs and therapeutic failures using the Naranjo ADWE algorithm and Therapeutic Failure Questionnaire.
- Development and initial testing of the chart review-based Naranjo ADWE algorithm in a nursing home population.
- Study of ADWEs in older outpatients using the Naranjo-based Drug Probability Withdrawal Scale.
MEASURES OF PATIENT, /CAREGIVER, AND CLINICIAN ATTITUDES AND DECISION-MAKING TOWARD DEPRESCRIBING
Several measures have been developed to measure attitudes and decision-making around deprescribing among patients, caregivers, and clinicians. This section lists several measurement tools and related work on this topic.
- The paper title says it all
- Evaluation of methods for handling missing data in rPATD questionnaire responses
- Development and validation of the Revised Patient Attitudes toward Deprescribing (rPATD) measure, the most commonly-used measure of patient and caregiver attitudes toward deprescribing. Variants are available for people with dementia and in several languages.
- Development and pilot testing of the Revised Patient Attitudes toward Deprescribing measure for people with cognitive impairment (rPATDcog).
- Novel typology of patient attitudes toward and decision-making processes around deprescribing.
- Development and validation of a measure of clinician opinions, preferences, and attitudes toward deprescribing (CHOPPED tool).
- Development of a short-form version of the Patient Perceptions of Deprescribing (PPoD) survey.
MEASURES OF QUALITY OF LIFE AND OTHER OUTCOMES IN DEPRESCRIBING STUDIES
- Scoping review of how quality of life can be measured in deprescribing trials
Intervention Studies
GENERAL RESOURCES FOR STUDIES OF DEPRESCRIBING INTERVENTIONS
These varied resources may be useful for investigators planning studies of deprescribing interventions.
- Overview of systematic reviews of deprescribing interventions
- Lessons learned from the OPTIMIZE pragmatic trial on deprescribing intervention design in cognitively impaired populations.
- Review of implementation considerations for deprescribing interventions.
- Description of a breakthrough series collaborative to support deprescribing interventions across VA healthcare settings.
PSCI change resources packet
- Deprescribing change resources from the VA Center for Medication Safety in Aging (supplement to paper above).
- Case study and learnings of how documentation data tools in an electronic health record were used to track pharmacist interventions for a deprescribing clinical trial.
- Survey study evaluating the attitudes of clinicians and investigators toward the conduct of deprescribing clinical trials.
CONCEPTUAL FRAMEWORKS OF DEPRESCRIBING
Several conceptual frameworks for deprescribing have been developed. These are useful both for clinical practice and for providing guidance on the development and implementation of deprescribing interventions. Several of the more-commonly cited frameworks are listed below, but this is not a comprehensive list.
- Comprehensive conceptual framework for advancing deprescribing science.
- Widely-cited conceptual framework for deprescribing.
- Conceptual framework for deprescribing that emphasizes the importance of patient context.
BEHAVIOR CHANGE AND IMPLEMENTATION SCIENCE CONCEPTS AND STRATEGIES FOR DEPRESCRIBING STUDIES
Behavior change and implementation science concepts and strategies are often essential components of deprescribing interventions. These resources (not a comprehensive list) describe how investigators have approached these issues in the context of deprescribing.
Ronquillo C, et al. An Implementation Science Perspective on Deprescribing. Oxford Academic. 2018
- Perspective on applying implementation science concepts to deprescribing.
- Commentary and literature synthesis on applying principles of behavior change to deprescribing interventions.
- Commentary on considerations for de-implementing inappropriate health interventions.
- Review of how deprescribing interventions map to components of the Behavior Change Wheel (an important implementation science framework).
- Qualitative study that explored how stakeholder voices could be used to design a deprescribing intervention.
N-OF-1 DEPRESCRIBING TRIALS
Several investigator groups have explored how N-of-1 methods can be applied to deprescribing.
Rationale and case study for using N-of-1 methods for deprescribing.
RECRUITMENT AND RETENTION FOR DEPRESCRIBING STUDIES
Recruitment and retention of older adults for deprescribing studies is often challenging. This paper provides insights on the topic and points toward strategies for maximizing successful participant recruitment and retention.
- Exploration of why older adults declined participation in clinical trials of deprescribing interventions.
Observational Studies
GENERAL RESOURCES FOR OBSERVATIONAL STUDIES OF DEPRESCRIBING
These varied resources may be useful for investigators planning studies of deprescribing interventions.
- Review of methodologies for evaluating the impact of deprescribing on clinical outcomes in observational studies.
Other Topics
PERSPECTIVES ON THE FIELD
These papers provide various perspectives on the past and future of deprescribing research.
- This commentary from participants in the USDeN Junior Investigator Intensive program presents a socioecological model for considering how deprescribing can occur when a patient is cared for by multiple prescribers.
- A critical look at reported mortality outcomes from deprescribing trials, with ideas and recommendations for increasing the rigor and representativeness of deprescribing trials.
- Commentary on the history of deprescribing research and what it means for the field, developed from a talk at the First International Conference on Deprescribing (2022).
- Commentary suggesting strategies and directions for future deprescribing research, developed from a talk at the First International Conference on Deprescribing (2022).
Thompson W, et al. Deprescribing: Future directions for research. Res Social Adm Pharm. 2019
- Consensus commentary on considerations for future deprescribing research, from a World Café workshop at the 2018 Bruyère Evidence-Based Deprescribing Guidelines Symposium.
- Consensus priorities for research on optimizing geriatric pharmacotherapy.
- Development and exploration of a taxonomy of deprescribing trials and implications for future research.
- Consensus list of 10 “must-read” deprescribing papers.
- Commentary on how interventions focused on deprescribing should be coupled vs. decoupled from other efforts to improve pharmacotherapy for older adults.
DEFINING DEPRESCRIBING
The word “deprescribing” can mean different things to different people. While different definitions have been offered, the following paper takes a thoughtful approach to the topic.
- Exploration of the definition and operationalization of the term “deprescribing.”
TOOLS FOR ASSESSSING MEDICATION APPROPIATENESS AND GUIDING DEPRESCRIBING RECCOMENDATIONS
Many tools exist for assessing medication appropriateness. Listed below are some recent summaries of available tools.
- Review of tools and guidelines to assess medication appropriateness
REPORTING RESULTS OF DEPRESCRIBING TRIALS
Standards for reporting results from a variety of study types have been developed. Why not for deprescribing too?
- Delphi panel recommendations for standardized reporting of results from deprescribing trials.
DEPRESCRIBING INVOLVING HISTORICALLLY MARGINALIZED COMMUNITITES
The vast majority of studies of deprescribing have been conducted among predominantly non-minoritized populations. Different methods and sensibilities may be required to support effective deprescribing among diverse populations, include those who have been historically marginalized by the health care system.
Essien UR, et al. Deprescribing Equity-A Research Framework for Older Adults. JAMA Intern Med. 2024
- Commentary providing a research framework for investigating equity in deprescribing.
- Qualitative study that explored attitudes and approaches toward deprescribing with an emphasis on African-American and Hispanic/Latino communities.
- Commentary on application of the principles of pharmacoequity to deprescribing.
INTERSECTION OF AGING, END-OF-LIFE CARE, LONG-TERM CARE, AND DEPRESCRIBING
Special considerations can affect deprescribing decisions, conversations, and interventions among older adults and among people nearing the end of life and people in long-term care settings. These papers explore some of these issues.
- Review and conceptual framework for conducting deprescribing research in nursing home settings using routinely collected data.
- Review of medication deprescribing instruments for palliative care settings
- Review of the “age-friendliness” of deprescribing interventions.
- Review and commentary on special opportunities and challenges for studies of deprescribing at the end of life.
ETHICS OF DEPRESCRIBING
Deprescribing involves taking something away, which raises special ethical principles in addition to ethical issues that arise more generally in prescribing and pharmacotherapy. These papers explore different aspects of this topic.
- Exploration of ethical issues in deprescribing.
Reeve E, et al. The Ethics of Deprescribing in Older Adults. J Bioeth Inq. 2016
- Another exploration of ethical issues in deprescribing.
- An exploration with physicians of ethical issues of deprescribing decisions in the population of people living with dementia.
- Tips for clinicians to engage in conversations with their patients and clinical colleagues on these issues.
VALUE ASSESSMENT IN DEPRESCRIBING
The cost-effectiveness of deprescribing interventions is a key consideration for health system leaders and policy makers.
- Commentary led by USDeN Junior Investigator Intensive scholars on value assessment in deprescribing.
- Selection of Outcome Measures
- Measurement of Deprescribing, Medication Use, and Treatment Intensity Using Electronic Health Records and Claims Data
- Measuring Adverse Drug Events and Adverse Drug Withdrawal Events in Deprescribing Studies
- Measures of Patient, Caregiver, and Clinician Attitudes and Decision-Making Toward Deprescribing
- Measures of Quality of Life and Other Outcomes in Deprescribing Studies
- General Resources for Studies of Deprescribing Interventions
- Conceptual Frameworks of Deprescribing
- Behavior Change and Implementation Science Concepts and Strategies for Deprescribing Studies
- N-of-1 Deprescribing Trials
- Recruitment and Retention for Deprescribing Studies
- General Resources for Observational Studies of Deprescribing
- Perspectives on the Field
- Defining Deprescribing
- Tools for Assessing Medication Appropriateness and Guiding Deprescribing Recommendations
- Reporting Results of Deprescribing Trials
- Deprescribing Involving Historicallly Marginalized Communitites
- Intersection of Aging, End-of-Life Care, Long-Term Care and Deprescribing
- Ethics of Deprescribing
- Value Assessment in Deprescribing
