Summary of the Research on EHR-Based Interventions for Medication Deprescribing in Older Adults
This research investigated the effectiveness of two electronic Health Record (EHR)-based interventions – precommitment and boostering – designed to encourage physicians to deprescribe perhaps inappropriate medications in older adults. Here’s a breakdown of the key findings:
What they did:
* Study Design: Randomized trial involving 1,146 patients (average age 73.6, 70% female).
* Interventions:
* Precommitment: Clinicians indicated in advance which patients they would consider for medication deprescribing, receiving an EHR inbox reminder approximately four weeks later if requested.
* Boostering: Clinicians received a list of patients potentially eligible for deprescribing via an EHR inbox reminder.
* Usual Care: no specific prompts or interventions.
* Outcome: Deprescribing defined as discontinuation, dose tapering, or nonrenewal of targeted medications, tracked using EHR data.
Key Findings:
* Increased Deprescribing: Both interventions significantly increased deprescribing rates compared to usual care.
* Precommitment: 40% relative increase (10.4% absolute increase)
* Boostering: 26% relative increase (6.5% absolute increase)
* Effectiveness Varied: Interventions were most effective for patients taking onyl one class of targeted medication.
* No Change in Overall Medication Exposure: While more medications were discontinued, there was no significant reduction in overall pill quantity or cumulative medication dose.
* Safety: No serious adverse events related to deprescribing were reported.Mortality rates were low, though numerically higher in the boostering group.
* Behavioral Nudges Work: The study demonstrates that simple, EHR-embedded behavioral nudges can change clinician behavior without requiring additional staff or patient programs.
Strengths of the Study:
* Randomized design
* integrated into routine clinical workflows
* Broad inclusion criteria
* Objective, EHR-based outcomes
* Pragmatic and generalizable to real-world settings
Limitations:
* Deprescribing outside the health system wasn’t captured.
* Passive discontinuation may not always be intentional.
* Lack of data on downstream clinical outcomes (falls, hospitalizations).
* Findings are specific to a single academic health system.
Overall Conclusion:
The study supports the use of behaviorally informed EHR tools as a scalable and effective way to reduce potentially inappropriate medication use in older adults. However, it also suggests that these tools are most effective when combined with other strategies to achieve a greater clinical impact.
Worth a look