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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 who received TRIM reports, clinicians did not engage with deintensification recommendations regarding overtreatment of chronic disease or difficulties with adherence and cognition. Authors point to the longstanding treatment intensification approach to chronic disease, or the “more is better” mindset, as the driving force behind these results. Overall, TRIM findings suggest that there are barriers to deprescribing beyond lack of awareness and information, such as psychological barriers and differences in priorities. Researchers conclude that an individualized feedback report like the TRIM promotes meaningful medication reconciliation but is only the first step toward effective deprescribing. Given the discrepancies between deprescribing knowledge and usual care, the uptake of deprescribing practices will require challenging the norms of prescribing and chronic disease management.

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