Patient-Directed Education to Promote Deprescribing: A Nonrandomized Clinical Trial

Area of Science:

• Gerontology and Geriatric Medicine
• Clinical Pharmacy
• Health Services Research

Background:

• Patient-directed educational materials are a promising strategy to increase medication deprescribing.
• Limited data exist on the impact of these materials across different medication classes with varying risk perceptions.

Purpose of the Study:

• To evaluate the effect of a patient-directed education intervention on clinician deprescribing of potentially low-benefit (proton pump inhibitors) or high-risk medications (high-dose gabapentin, diabetes agents with hypoglycemia risks).

Main Methods:

• A pragmatic, multisite, nonrandomized clinical trial involving 5071 patients across 3 US Veterans Affairs medical centers.
• The intervention involved mailing medication-specific brochures to patients 2-3 weeks before primary care appointments.
• A historical control cohort, seen by the same primary care practitioners (PCPs) one year prior, was used for comparison.

Main Results:

• The intervention group showed a higher deprescribing rate (29.5%) compared to the control group (25.8%), a statistically significant difference (adjusted odds ratio: 1.21; P=.008).
• Deprescribing rates increased for proton pump inhibitors, high-dose gabapentin, and diabetes agents associated with hypoglycemia risk.
• The intervention's effectiveness did not significantly differ across the medication groups studied.

Conclusions:

• Patient-directed educational materials, delivered before primary care appointments, can effectively promote deprescribing of potentially low-benefit and high-risk medications.
• This intervention represents a viable strategy to enhance deprescribing efforts in clinical practice.