Advancing deprescribing: Learnings from the first international conference on deprescribing

Lundby, Carina; Thompson, Wade

doi:10.1111/bcpt.13963

Cited by 4 publications

(1 citation statement)

References 33 publications

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“…A cluster-randomized trial is considered optimal to account for clustering of patients within HCP teams. By comprehensively evaluating the intervention by means of a mixed-methods process evaluation at HCP and patient level and conducting an economic evaluation alongside to the effect evaluation including a range of clinical and patient-reported outcomes, it is expected to fill gaps in knowledge needed for sustainable implementation of deprescribing [ 72 , 73 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of a multicomponent communication training to involve older people in decisions to DEPRESCRIBE cardiometabolic medication in primary care (CO-DEPRESCRIBE): protocol for a cluster randomized controlled trial with embedded process and economic evaluation

Stuijt,

Heringa,

van Dijk

et al. 2024

BMC Prim. Care

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Background Deprescribing of medication for cardiovascular risk factors and diabetes has been incorporated in clinical guidelines but proves to be difficult to implement in primary care. Training of healthcare providers is needed to enhance deprescribing in eligible patients. This study will examine the effects of a blended training program aimed at initiating and conducting constructive deprescribing consultations with patients. Methods A cluster-randomized trial will be conducted in which local pharmacy-general practice teams in the Netherlands will be randomized to conducting clinical medication reviews with patients as usual (control) or after receiving the CO-DEPRESCRIBE training program (intervention). People of 75 years and older using specific cardiometabolic medication (diabetes drugs, antihypertensives, statins) and eligible for a medication review will be included. The CO-DEPRESCRIBE intervention is based on previous work and applies models for patient-centered communication and shared decision making. It consists of 5 training modules with supportive tools. The primary outcome is the percentage of patients with at least 1 cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision making, healthcare provider communication skills, health/medication-related outcomes, attitudes towards deprescribing, medication regimen complexity and health-related quality of life. Additional safety and cost parameters will be collected. It is estimated that 167 patients per study arm are needed in the final intention-to-treat analysis using a mixed effects model. Taking loss to follow-up into account, 40 teams are asked to recruit 10 patients each. A baseline and 6-months follow-up assessment, a process evaluation, and a cost-effectiveness analysis will be conducted. Discussion The hypothesis is that the training program will lead to more proactive and patient-centered deprescribing of cardiometabolic medication. By a comprehensive evaluation, an increase in knowledge needed for sustainable implementation of deprescribing in primary care is expected. Trial registration The study is registered at ClinicalTrials.gov (identifier: NCT05507177).

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Section: Discussionmentioning

confidence: 99%