Engaging Patients in Discussions About Medication Deprescribing.

Abstract

Background: Deprescribing, intentional medication discontinuation or dose reduction, can reduce potentially inappropriate medication use and medication-related harms. Engaging patients in deprescribing discussions may increase likelihood of deprescribing and promote shared decision-making.

Objective: To examine the impact of patient-directed educational brochures on patient engagement and deprescribing discussions with primary care providers (PCPs).

Design: We mailed medication-specific brochures 2 weeks prior to each patient's PCP appointment (4/12/2021-10/7/2022), followed by a mailed survey 2 weeks after scheduled PCP visits.

Participants: Patients from three Veterans Affairs facilities with scheduled PCP appointments eligible for one of three medication-based cohorts (proton pump inhibitor, gabapentin, diabetes-hypoglycemia risk).

Main measures: Our primary outcome was patient-reported deprescribing discussions with their PCP (yes/no). Descriptive statistics characterized engagement with and reactions to the brochure. Multivariable logistic regression models determined associations of patient characteristics, attitudes, and brochure-engagement with reported deprescribing discussions.

Key results: Adjusting only for patient characteristics, discussions were less likely if respondents were Black (vs. White: OR 0.47, 95% CI 0.29-0.78) and more likely with higher education level (e.g., advanced degree vs. high school or less: OR 2.39, 95% CI 1.53-3.73), and adequate health literacy (OR 1.84, 95% CI 1.16-2.92). After further adjusting for general deprescribing attitudes and brochure engagement, discussions were more likely if respondents completed brochure activities (vs. did not read brochures: OR 2.23, 95% CI 1.39-3.59), contacted their PCPs prior to their visits (OR 2.47, 95% CI 1.34, 4.58), or discussed the brochure with family/friends (OR 1.72, 95% CI 1.22-2.41) or a healthcare provider (OR 3.18, 95% CI 2.08-4.85).

Conclusions: Patient characteristics and brochure engagement were associated with deprescribing discussions. Patient-centered deprescribing brochures can foster patient engagement and inclusion of patient perspectives into deprescribing decisions. Future studies should explore implementation strategies that promote greater deprescribing reach and adoption among patients with lower health literacy.