Effectiveness of Patient-Directed Education to Sustain Deprescribing: A Pragmatic Trial.
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...
| Publicado en: | Drugs & Aging Vol. 42; no. 11; pp. 1073 - 1084 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Springer Nature
Nov2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=188949811&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 188949811 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1170229X C5B jtl: Drugs & Aging issn: 1170229X maglogo: N pubinfo: dt: Nov2025 vid: 42 iid: 11 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 188949811 188705502 188949811 188949811 10.1007/s40266-025-01251-z 188949811 ppf: 1073 ppct: 11 formats: tig: atl: Effectiveness of Patient-Directed Education to Sustain Deprescribing: A Pragmatic Trial. aug: au: Jones, Katie Fitzgerald Stolzmann, Kelly Wormwood, Jolie Pendergast, Jacquelyn Miller, Christopher J. Still, Michael Bokhour, Barbara G. Hanlon, Joseph Simon, Steven R. Rosen, Amy K. Linsky, Amy M. affil: https://ror.org/04v00sg98 New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, 150 South Huntington Ave, 02130, Jamaica Plain, MA, USA sug: subj: Patient Education Outcomes of Education Patient Safety Patient Participation Implementation Science Deprescribing Proton Pump Inhibitors Administration and Dosage Gabapentin Administration and Dosage Hypoglycemic Agents Administration and Dosage Human Randomized Controlled Trials Random Assignment Inappropriate Prescribing Prevention and Control Clinical Assessment Tools Hypoglycemia Risk Factors Risk Assessment Prospective Studies Multiple Logistic Regression Odds Ratio Descriptive Statistics Confidence Intervals Primary Health Care Hospitals, Veterans California New York Massachusetts Multicenter Studies Physicians, Family Primary Care Nurse Practitioners Physician Assistants Data Analysis Software T-Tests Chi Square Test Funding Source ab: 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. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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