Skip to main content
Top

29-01-2025 | Gabapentin | Original Research

Engaging Patients in Discussions About Medication Deprescribing

Authors: Jacquelyn Pendergast, MS, Jolie B. Wormwood, PhD, Kelly Stolzmann, MS, Amy K. Rosen, PhD, Katie Fitzgerald Jones, PhD, ACHPN, Christopher J. Miller, PhD, Michael Still, MS, Barbara Bokhour, PhD, Joseph T. Hanlon, PharmD, MS, Steven R. Simon, MD, MPH, Amy M. Linsky, MD, MSc

Published in: Journal of General Internal Medicine

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics. 2017;17:1-10.CrossRef Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics. 2017;17:1-10.CrossRef
2.
go back to reference Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Therapeut Adv Drug Saf. 2020;11:2042098620933741.CrossRef Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Therapeut Adv Drug Saf. 2020;11:2042098620933741.CrossRef
3.
go back to reference Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65.CrossRefPubMed Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65.CrossRefPubMed
4.
go back to reference Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Int Med. 2015;175(5):827-834.CrossRef Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Int Med. 2015;175(5):827-834.CrossRef
5.
go back to reference Moen J, Bohm A, Tillenius T, Antonov K, Nilsson JLG, Ring L. “I don’t know how many of these [medicines] are necessary..”—A focus group study among elderly users of multiple medicines. Patient Educ Couns. 2009;74(2):135–141. Moen J, Bohm A, Tillenius T, Antonov K, Nilsson JLG, Ring L. “I don’t know how many of these [medicines] are necessary..”—A focus group study among elderly users of multiple medicines. Patient Educ Couns. 2009;74(2):135–141.
6.
go back to reference Linsky A, Simon SR, Bokhour B. Patient perceptions of proactive medication discontinuation. Patient Educ Couns. 2015;98(2):220-225.CrossRefPubMed Linsky A, Simon SR, Bokhour B. Patient perceptions of proactive medication discontinuation. Patient Educ Couns. 2015;98(2):220-225.CrossRefPubMed
7.
go back to reference Linsky A, Zimmerman KM. Provider and system-level barriers to deprescribing: interconnected problems and solutions. Public Policy Aging Rep. 2018;28(4):129-133.CrossRef Linsky A, Zimmerman KM. Provider and system-level barriers to deprescribing: interconnected problems and solutions. Public Policy Aging Rep. 2018;28(4):129-133.CrossRef
8.
go back to reference Linsky A, Simon SR, Marcello TB, Bokhour B. Clinical provider perceptions of proactive medication discontinuation. Am J Manag Care. 2015;21(4):277-283.PubMed Linsky A, Simon SR, Marcello TB, Bokhour B. Clinical provider perceptions of proactive medication discontinuation. Am J Manag Care. 2015;21(4):277-283.PubMed
9.
go back to reference Hung A, Sloan CE, Boyd C, Bayliss EA, Hastings SN, Maciejewski ML. Deprescribing medications: Do out-of-pocket costs have a role? J Am Geriatr Soc. 2022;70(11):3334.CrossRefPubMedPubMedCentral Hung A, Sloan CE, Boyd C, Bayliss EA, Hastings SN, Maciejewski ML. Deprescribing medications: Do out-of-pocket costs have a role? J Am Geriatr Soc. 2022;70(11):3334.CrossRefPubMedPubMedCentral
10.
12.
go back to reference Dang S. Shared Decision Making-The Pinnacle of Patient-Centered Care. J Indian Acad Geriatr. 2018;14. Dang S. Shared Decision Making-The Pinnacle of Patient-Centered Care. J Indian Acad Geriatr. 2018;14.
13.
go back to reference Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006;60(3):301-312.CrossRefPubMed Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006;60(3):301-312.CrossRefPubMed
14.
go back to reference Fraenkel L, McGraw S. What are the essential elements to enable patient participation in medical decision making? J Gen Int Med. 2007;22:614-619.CrossRef Fraenkel L, McGraw S. What are the essential elements to enable patient participation in medical decision making? J Gen Int Med. 2007;22:614-619.CrossRef
15.
go back to reference Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? Deprescribing through shared decision making. Bmj. 2016;353. Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? Deprescribing through shared decision making. Bmj. 2016;353.
16.
go back to reference Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence‐based, patient‐centred deprescribing process. British J Clin Pharmacol. 2014;78(4):738-747.CrossRef Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence‐based, patient‐centred deprescribing process. British J Clin Pharmacol. 2014;78(4):738-747.CrossRef
17.
go back to reference Martin P, Tamblyn R, Ahmed S, Tannenbaum C. An educational intervention to reduce the use of potentially inappropriate medications among older adults (EMPOWER study): protocol for a cluster randomized trial. Trials. 2013;14:1-11.CrossRef Martin P, Tamblyn R, Ahmed S, Tannenbaum C. An educational intervention to reduce the use of potentially inappropriate medications among older adults (EMPOWER study): protocol for a cluster randomized trial. Trials. 2013;14:1-11.CrossRef
18.
go back to reference Fajardo MA, Weir KR, Bonner C, Gnjidic D, Jansen J. Availability and readability of patient education materials for deprescribing: an environmental scan. British J Clin Pharmacol. 2019;85(7):1396-1406.CrossRef Fajardo MA, Weir KR, Bonner C, Gnjidic D, Jansen J. Availability and readability of patient education materials for deprescribing: an environmental scan. British J Clin Pharmacol. 2019;85(7):1396-1406.CrossRef
19.
go back to reference Mack A. Examination of the evidence for off-label use of gabapentin. J Manag Care Pharm. 2003;9(6):559-568.PubMed Mack A. Examination of the evidence for off-label use of gabapentin. J Manag Care Pharm. 2003;9(6):559-568.PubMed
20.
go back to reference Yan PZ, Butler PM, Kurowski D, Perloff MD. Beyond neuropathic pain: gabapentin use in cancer pain and perioperative pain. Clin J Pain. 2014;30(7):613-629.CrossRefPubMed Yan PZ, Butler PM, Kurowski D, Perloff MD. Beyond neuropathic pain: gabapentin use in cancer pain and perioperative pain. Clin J Pain. 2014;30(7):613-629.CrossRefPubMed
22.
go back to reference Hypoglycemia A. Defining and reporting hypoglycemia in diabetes. Diabetes Care. 2005;28(5):1245.CrossRef Hypoglycemia A. Defining and reporting hypoglycemia in diabetes. Diabetes Care. 2005;28(5):1245.CrossRef
23.
go back to reference Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Int Med. 2014;174(6):890-898.CrossRef Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Int Med. 2014;174(6):890-898.CrossRef
24.
go back to reference Martin P, Tamblyn R, Ahmed S, Tannenbaum C. A drug education tool developed for older adults changes knowledge, beliefs and risk perceptions about inappropriate benzodiazepine prescriptions in the elderly. Patient Educ Couns. 2013;92(1):81-87.CrossRefPubMed Martin P, Tamblyn R, Ahmed S, Tannenbaum C. A drug education tool developed for older adults changes knowledge, beliefs and risk perceptions about inappropriate benzodiazepine prescriptions in the elderly. Patient Educ Couns. 2013;92(1):81-87.CrossRefPubMed
25.
go back to reference Martin P, Tamblyn R, Ahmed S, Benedetti A, Tannenbaum C. A consumer-targeted, pharmacist-led, educational intervention to reduce inappropriate medication use in community older adults (D-PRESCRIBE trial): study protocol for a cluster randomized controlled trial. Trials. 2015;16:1-11.CrossRef Martin P, Tamblyn R, Ahmed S, Benedetti A, Tannenbaum C. A consumer-targeted, pharmacist-led, educational intervention to reduce inappropriate medication use in community older adults (D-PRESCRIBE trial): study protocol for a cluster randomized controlled trial. Trials. 2015;16:1-11.CrossRef
26.
go back to reference Epstein RM, Street Jr RL. Patient-centered communication in cancer care: promoting healing and reducing suffering. 2007. Epstein RM, Street Jr RL. Patient-centered communication in cancer care: promoting healing and reducing suffering. 2007.
27.
go back to reference Duke CC, Lynch WD, Smith B, Winstanley J. Validity of a new patient engagement measure: the Altarum Consumer Engagement (ACE) Measure™. Patient-Patient-Centered Outcome Res. 2015;8:559-568.CrossRef Duke CC, Lynch WD, Smith B, Winstanley J. Validity of a new patient engagement measure: the Altarum Consumer Engagement (ACE) Measure™. Patient-Patient-Centered Outcome Res. 2015;8:559-568.CrossRef
28.
go back to reference Linsky AM, Stolzmann K, Meterko M. The patient perceptions of deprescribing (PpoD) survey: short-form development. Drugs Aging. 2020;37(12):909-916.CrossRefPubMed Linsky AM, Stolzmann K, Meterko M. The patient perceptions of deprescribing (PpoD) survey: short-form development. Drugs Aging. 2020;37(12):909-916.CrossRefPubMed
30.
go back to reference Nallapeta N, Reynolds JL, Bakhai S. Deprescribing proton pump inhibitors in an academic, primary care clinic: quality improvement project. J Clinical Gastroenterol. 2020;54(10):864-870.CrossRef Nallapeta N, Reynolds JL, Bakhai S. Deprescribing proton pump inhibitors in an academic, primary care clinic: quality improvement project. J Clinical Gastroenterol. 2020;54(10):864-870.CrossRef
31.
go back to reference Lukacena KM, Keck JW, Freeman PR, Harrington NG, Huffmyer MJ, Moga DC. Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists. Ther Adv Drug Saf. 2022;13:20420986221116465.CrossRefPubMedPubMedCentral Lukacena KM, Keck JW, Freeman PR, Harrington NG, Huffmyer MJ, Moga DC. Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists. Ther Adv Drug Saf. 2022;13:20420986221116465.CrossRefPubMedPubMedCentral
32.
go back to reference Green AR, Boyd CM, Gleason KS, et al. Designing a primary care–based deprescribing intervention for patients with dementia and multiple chronic conditions: a qualitative study. J Gen Int Medicine. 2020;35:3556-3563.CrossRef Green AR, Boyd CM, Gleason KS, et al. Designing a primary care–based deprescribing intervention for patients with dementia and multiple chronic conditions: a qualitative study. J Gen Int Medicine. 2020;35:3556-3563.CrossRef
33.
go back to reference Boyd RW, Lindo EG, Weeks LD, McLemore MR. On racism: a new standard for publishing on racial health inequities. Health Aff Forefront. 2020; Boyd RW, Lindo EG, Weeks LD, McLemore MR. On racism: a new standard for publishing on racial health inequities. Health Aff Forefront. 2020;
34.
go back to reference Zisman-Ilani Y, Khaikin S, Savoy ML, et al. Disparities in shared decision-making research and practice: the case for black American patients. Ann Fam Med. 2023;21(2):112-118.CrossRefPubMedPubMedCentral Zisman-Ilani Y, Khaikin S, Savoy ML, et al. Disparities in shared decision-making research and practice: the case for black American patients. Ann Fam Med. 2023;21(2):112-118.CrossRefPubMedPubMedCentral
35.
36.
go back to reference Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of attitudes toward deprescribing in older Medicare beneficiaries in the United States. JAMA Int Med. 2018;178(12):1673-1680.CrossRef Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of attitudes toward deprescribing in older Medicare beneficiaries in the United States. JAMA Int Med. 2018;178(12):1673-1680.CrossRef
37.
go back to reference National Center for Veterans Analysis and Statistics. Profile of Veterans 2017; 2019. National Center for Veterans Analysis and Statistics. Profile of Veterans 2017; 2019.
38.
go back to reference Mehta HB, Li S, An H, Goodwin JS, Alexander GC, Segal JB. Development and validation of the summary Elixhauser Comorbidity Score for use with ICD-10-CM–coded data among older adults. Ann Int Med. 2022;175(10):1423-1430.CrossRefPubMed Mehta HB, Li S, An H, Goodwin JS, Alexander GC, Segal JB. Development and validation of the summary Elixhauser Comorbidity Score for use with ICD-10-CM–coded data among older adults. Ann Int Med. 2022;175(10):1423-1430.CrossRefPubMed
Metadata
Title
Engaging Patients in Discussions About Medication Deprescribing
Authors
Jacquelyn Pendergast, MS
Jolie B. Wormwood, PhD
Kelly Stolzmann, MS
Amy K. Rosen, PhD
Katie Fitzgerald Jones, PhD, ACHPN
Christopher J. Miller, PhD
Michael Still, MS
Barbara Bokhour, PhD
Joseph T. Hanlon, PharmD, MS
Steven R. Simon, MD, MPH
Amy M. Linsky, MD, MSc
Publication date
29-01-2025
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-024-09346-w

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more