Deprescribing, Statin Prescribing
Conditions
Brief summary
We will use EHR data to identify eligible patients at BWH primary care clinics. Patients will be eligible if they have an upcoming primary care provider (PCP) appointment at an included BWH clinic, are ≥65 years, and are eligible for a medication target; exclusion criteria will include relevant EHR-documented allergies. After sharing patients with PCPs for potential opt-out, patients will be randomized 1:1 in REDCap® to intervention or usual care (no prompt). The intervention will include a pre-visit patient-facing prompt with information about the evidence-based medication target. If patients are eligible for multiple targets, one will be randomly selected. The primary clinical outcome will be measured on the day of the PCP visit using EHR data, depending on target: a) discontinuation or tapering order, or b) prescribing. Secondary outcomes will include a) these same measures in a 60-day follow-up period after the visit to capture any follow-up actions. We will use an intention-to-treat approach including patients regardless of whether the visit occurred. We plan to conduct the trial until 1700 patients are reached. We will also conduct exploratory mediation analyses of mechanisms through brief patient surveys with behavioral scales and PCP survey.
Interventions
BEHAVIORALPre-visit prompts
The intervention itself is a pre-visit prompt delivered prior to upcoming visits that includes a brief recommendation to the patient to discuss the medication use target with the PCP at the visit and a handout about the medication. The medication targets include potentially-inappropriate medications and statin prescribing.
Sponsors
Brigham and Women's Hospital
National Institute on Aging (NIA)
University of Southern California
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ≥65 years of age * Have an upcoming clinic appointment with a BWH PCP at one of the included clinics In addition, they must meet the following eligibility criteria for at least one medication target behavior (based on EHR data): 1. Statin use for primary prevention (65-75 years of age): Having a EHR diagnosis or problem list documentation of: diabetes, hypertension, smoking, or high cholesterol and estimated eligible cardiovascular risk 2. High-risk medication use (≥65 years of age): Have an active outpatient prescription for ≥1 medication on the American Geriatrics Society Beers Criteria® List for Avoid Medications based on EHR records
Exclusion criteria
* Documented allergy to one of the components (statin) * Current or recent prescription for a statin or PCSK9-inhibitor or bempedoic acid * Primary language recorded other than English or Spanish
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Completion of medication prescribing/deprescribing target on day of PCP visit | 1 day | The primary clinical outcome will be measured on the day of the primary care provider (PCP) visit through EHR data, depending on medication target: a) discontinuation or taper, or b) statin prescribing. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Completion of medication prescribing/deprescribing target within 60 days | 60 days | The secondary clinical outcome will be measured within the 60-day follow-up on or after the primary care provider (PCP) visit through EHR data, depending on medication target: a) discontinuation or taper, or b) statin prescribing. |
Countries
United States
Outcome results
None listed