From trials to real world: Implementing deprescribing

By Judith Garber | April 4, 2021

Deprescribing — stopping or reducing the dose of unnecessary or potentially harmful medications– is critical if we want to reduce medication overload in older Americans. Yet stopping prescriptions is often much harder than it sounds, because our health care system is set up to make it easy for clinicians to prescribe, and hard for them to deprescribe. Clinicians don’t always know all of the medications their patients are taking, and they might feel not informed enough or that they don’t have enough time to explain all the benefits and harms of these medications.

Fortunately, researchers have found that direct-to-patient advertising can help patients start the conversation about deprescribing. The EMPOWER trial in Quebec, Canada, found that sending informational brochures to older adults taking sedative-hypnotic medications (such as Xanax and Valium) led to a large 22 percent greater reduction in their use compared to a control group who did not receive brochures. Sixty-two percent of participants in the intervention group initiated a conversation about deprescribing with a clinician. A subsequent randomized trial in Quebec called D-PRESCRIBE showed that combining patient brochures with recommendations from pharmacists to primary care physicians had an even greater impact on deprescribing.

Can the examples from these trials be applied on a larger scale? How do we go from trial to real world? In a webinar hosted by the US Deprescribing Research Network, Dr. Justin Turner, assistant professor at the faculty of pharmacy at University of Montreal and co-director of the Canadian Deprescribing Network (CADEN) tackled these questions in detail.

Turner and CADEN have been using Implementation Science (IS) to understand what influences the behavior of doctors and patients, and what could make them change. IS is the study of methods to promote the systematic uptake of evidence-based research into routine health care practice. IS tries to bridge the gap between “What we know” to “What we do.” Turner explains how they used different theoretical IS models to scale up the EMPOWER and D-PRESCRIBE trials, and what they learned.

Watch the video above to see the full webinar and access the slides on the US Deprescribing Research Network website!

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.