A recent study published in JAMA Internal Medicine reveals that patient-directed educational materials can effectively promote the deprescribing of medications with potentially low benefit or high risk. The pragmatic multisite nonrandomized clinical trial, conducted across three US Veterans Affairs (VA) medical centers, demonstrated a statistically significant increase in deprescribing of proton pump inhibitors (PPIs), high-dose gabapentin, and diabetes agents associated with hypoglycemia risk.
The study, which took place from April 2021 to October 2022, involved 5071 patients under the care of 103 primary care practitioners (PCPs). The intervention consisted of medication-specific brochures mailed to eligible patients 2 to 3 weeks before their primary care appointments. A historical control cohort, consisting of patients seen by the same PCPs at the same sites one year prior to the intervention, was used for comparison.
The primary outcome was deprescribing within 6 months after the intervention, defined as complete cessation or any dose reduction of the target medication, assessed using VA pharmacy dispensing data. Results showed that the overall rate of deprescribing in the intervention cohort (n=2539) was 29.5%, compared to 25.8% in the control cohort (n=2532). This difference was statistically significant, with an odds ratio (OR) of 1.17 (95% CI, 1.03-1.33; P=.02) in an unadjusted model. After adjusting for patient and PCP characteristics, the odds of deprescribing in the intervention cohort were 1.21 times that of the control cohort (95% CI, 1.05-1.38; P=.008).
"Patient-directed educational materials are a promising implementation strategy to expand deprescribing reach and adoption," the authors noted. The difference in deprescribing prevalence between the intervention and control cohorts did not significantly differ by medication group (PPIs: 29.4% vs 25.4%; gabapentin: 40.2% vs 36.2%; hypoglycemia risk: 27.3% vs 25.1%; P=.90).
Implications for Clinical Practice
The findings suggest that providing patients with targeted educational materials before their appointments can empower them to engage in informed discussions with their physicians about the necessity and risks of their medications. This approach is particularly relevant for medications like PPIs, which are often overprescribed, and gabapentin, which carries risks at high doses, as well as diabetes medications that pose a risk of hypoglycemia.
Study Limitations
The authors acknowledge that the study was a nonrandomized clinical trial, which introduces the potential for selection bias. However, the use of a historical control group and multivariable regression modeling helped to mitigate this risk. Further research, including randomized controlled trials, is warranted to confirm these findings and explore the optimal strategies for implementing patient-directed education to promote deprescribing.
