Integrating patient education on deprescribing into care delivery: Learnings from the Optimize pragmatic trial

Deprescribing is not well integrated into clinical practice and improving patient education is recommended to foster deprescribing communication. Based on our experience developing, adapting, and implementing the Optimize deprescribing educational intervention for persons living with dementia, we discuss lessons learned in providing deprescribing education to patients and family members or other care partners.

The Optimize study was a cluster randomized, pragmatic trial in primary care that provided deprescribing education to individuals with cognitive impairment, polypharmacy and multiple chronic conditions, and their care partners. The initial intervention provided materials by mail ahead of visits. The delayed control intervention provided materials at the point of care. In 28 semi-structured interviews with 16 patients alone, 10 patient-caregiver dyads, and 2 caregivers alone, conducted across both intervention arms and analyzed using the framework method for implementation assessment, participants reflected on approaches to providing educational materials to support deprescribing in primary care.

Patients and care partners welcomed receiving educational materials about deprescribing. Patients and care partners had varying suggestions for modes of materials delivery (e.g., online, mail, with prescriptions). Competing demands at the point of care interfered with clinic staff distributing materials at that time, although some patients were theoretically agreeable to this approach. Providers requested timing materials delivery to align with clinical encounters that foster discussing medications and goals of care.

These pragmatic learnings suggest that operational approaches to deprescribing education for polypharmacy include multiple team members and multiple modes of delivering information about deprescribing and polypharmacy to patients and care partners. Detailed approaches deserve further investigation.