Engaging Patients to Promote Deprescribing (CO301A)

Outcomes 1. Understand the potential and impact of patient-centered interventions to facilitate deprescribing. 2. Apply the evidence from our implementation research hybrid-type I multisite randomized controlled trial to increase the uptake of deprescribing in their clinical and research settings. Key Message Inappropriate medication use and polypharmacy is a common issue among palliative care populations and older adults. Deprescribing (proactively stopping or de-escalating a medication) can offer a multitude of benefits. Here, we describe the significant impact of a patient-directed intervention for deprescribing proton pump inhibitors (PPIs), sulfonylureas/insulin, and high-dose gabapentin. Importance Deprescribing (proactively stopping or de-escalating a medication) offers a multitude of benefits for older adults and palliative care populations.(1,2) Patient-focused deprescribing interventions have potential to facilitate deprescribing.(3) Objectives We conducted a multisite randomized controlled trial to examine the impact of a patient-centered deprescribing intervention. We hypothesized greater deprescribing for participants receiving an informational deprescribing brochure compared to control subjects. We targeted proton pump inhibitors (PPIs), sulfonylureas/insulin, and high-dose gabapentin. These medications are named in the OncPal deprescribing guideline and may offer limited benefits to older adults and palliative care populations.(4,5) Scientific Methods Utilized We identified Veterans meeting eligibility criteria for one of the three medication-based groups at three VA Medical Centers with scheduled primary care appointments from 4/2021-10/2022 and mailed them the applicable brochure. Our control cohort consisted of Veterans who would have been eligible in each medication group and seen by study providers from 10/2019-4/2020. The primary outcome – deprescribing – was assessed 6 months post intervention. We calculated basic descriptive statistics to characterize study cohorts. We identified associations between our primary outcome of deprescribing and patient and provider characteristics using hierarchical generalized linear modeling to account for the nesting of patients within providers and providers within medical centers. Results The total sample comprised the intervention cohort (n=2539) and the control cohort (n=2532). Intervention subjects were significantly more likely to have deprescribing (OR 1.17; 95% CI 1.03-1.33; p=0.017) compared to controls. In hierarchical multivariable models, the intervention cohort was 1.21 times more likely to have deprescribing compared to controls (95%CI 1.05-1.38; p=0.008). Compared to the other groups gabapentin (OR 1.8, 95% CI 1.31-2.48) had greater odds of deprescribing. Conclusion(s) Patient-directed educational materials are an effective, low-tech intervention to promote deprescribing. Impact Inappropriate medication use is a common and relevant issue among palliative care populations and older adults. Incorporating patient-engagement strategies can increase the clinical uptake of deprescribing. Keywords Pain and symptom control/Palliative care in chronic, non-malignant illness