| Sumario: | Background: More than one in three older adults use potentially inappropriate medications (PIMs), and those with chronic conditions are more likely to be on multiple PIMs. Deprescribing, defined as stopping or dose-reducing a medication, can avoid harms from PIMs. Despite its benefits, deprescribing is rarely adopted into clinical practice. Objectives: We examined the effectiveness, sustainability, and safety of a patient-engagement strategy in a pragmatic trial at three facilities. Methods: Subjects were mailed brochures for one of three PIMs (proton pump inhibitors, high-dose gabapentin, and diabetes agents with hypoglycemia risk) if they had chronic active prescriptions before a primary care provider (PCP) visit. Control subjects received usual care. Results: There were 2448 patients in the control group (n = 2448) and 2480 patients in the implementation strategy cohort (n = 2480). In a mixed effect multivariable logistic regression model with PCP and site treated as random factors and controlling for patient and PCP characteristics, implementation strategy patients were significantly more likely to have deprescribing at 12-months compared with controls (odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.04, 1.35; p = 0.012). In a multinomial logistic regression model controlling for patient characteristics, implementation strategy patients were significantly more likely to exhibit sustained deprescribing (deprescribing at 6 and 12 months, OR = 1.32 [95% CI = 1.13, 1.55]) but not short-term (6 months only, OR = 0.96 [95% CI = 0.79, 1.16]) or delayed (12 months only, OR = 0.99 [95% CI = 0.84, 1.17]) deprescribing. There were five potential severe adverse drug withdrawals (0.2% incidence rate) possibly related to deprescribing. Conclusions: Despite low intensity, patient-directed education materials are an effective and safe implementation strategy to promote and sustain deprescribing. Trial Registration: ClinicalTrials.gov, NCT0429490, NCT04294901.
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