TOPLINE:

Electronic health record (EHR) interventions using behavioral science principles increased deprescribing of potentially inappropriate medications by 40% in older adults compared with usual care. The precommitment intervention boosted deprescribing rates to 36.8% compared with 26.8% in usual care, while the boostering intervention achieved a 34.3% rate.

METHODOLOGY:

• A 3-group parallel randomized clinical trial included 201 primary care physicians (PCPs) cluster-randomized in November 2022, with follow-up ending March 15, 2024.
• Participants included patients aged 65 years or older prescribed at least 90 pills of benzodiazepines, nonbenzodiazepine sedative hypnotics, or at least two anticholinergic medications in the past 180 days.
• PCPs were randomized to usual care, precommitment intervention (EHR messages encouraging deprescribing discussions and reminders), or boostering intervention (EHR notifications with 4-week follow-up reminders).
• The primary outcome measured physician-directed discontinuation or medication tapering through EHR data, with analyses using generalized estimating equations adjusted for clustering.

TAKEAWAY:

• Among 1146 patients (mean age, 73.6 years; 69.7% female), the precommitment group showed 40% higher likelihood of deprescribing vs usual care (relative risk [RR], 1.40; 95% CI, 1.14-1.73; absolute difference, 10.4%).
• The boostering intervention increased deprescribing likelihood by 26% compared with usual care (RR, 1.26; 95% CI, 1.01-1.57; absolute difference, 6.5%).
• Subgroup analyses revealed stronger effects in patients using single medication classes, with precommitment showing 58% higher deprescribing rates (RR, 1.58; 95% CI, 1.23-2.03) and boostering showing 35% higher rates (RR, 1.35; 95% CI, 1.03-1.76).
• Death rates based on manual chart review were 1.4% in precommitment, 3.9% in boostering, and 1.8% in usual care groups.

IN PRACTICE:

“These results support use of EHR tools designed using behavioral science principles to significantly increase rates of deprescribing potentially inappropriate medications used by older adults,” the authors of the study wrote.

SOURCE:

The study was led by Julie C. Lauffenburger, PharmD, PhD, Brigham and Women’s Hospital and Harvard Medical School in Boston. It was published online on January 29 in JAMA.

LIMITATIONS:

According to the authors, patients might have had deprescribing performed outside of the study health system. Additionally, passive deprescribing may have included patients who had already stopped medication by the index visit or had moved away. The intervention exposure could have influenced physicians’ prescribing patterns, potentially preventing some patients from initiating target medications during the trial.

DISCLOSURES:

The study was supported by grant R33AG057388 from the National Institute on Aging. Robert J. Glynn, ScD, PhD, reported receiving grants from Amarin, Kowa, and Novartis outside the submitted work. Niteesh K. Choudhry, MD, PhD, disclosed serving as a consultant to Veracity Health Care Analytics and holding equity in RxAnte. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.