Brochures mailed to patients may aid deprescribing efforts, study finds
A previsit brochure was associated with a ninefold increase in the odds of deprescribing conversations with care teams among veterans who found the topic important.
Medication-specific brochures are an effective and low-cost way to promote shared-decision making for medication deprescribing, a study found.
To examine the impact of patient-directed educational brochures on patient engagement and deprescribing discussions with primary care clinicians, researchers mailed patients medication-specific brochures two weeks before their appointments at one of three Veterans Affairs facilities. Researchers then mailed a survey two weeks after visits to patients taking one of three types of medicines: a proton-pump inhibitor (PPI), gabapentin, or drugs for diabetes that may cause hypoglycemia.
Veterans were asked about their demographic and health characteristics, health literacy, consumer engagement, motivation for deprescribing, relationship with their clinician, actions taken after brochure receipt, concerns triggered by the brochure, importance of discussing the medicine at their primary care visit, and previsit preference about stopping the medication. Finally, patients were asked whether they discussed the medication of interest at their primary care visit, who initiated the discussion, and if the brochure was discussed. The primary outcome was patient-reported deprescribing discussions (yes/no). Results were published Jan. 29 in the Journal of General Internal Medicine.
Among 3,206 patients who met the inclusion criteria, there were 1,382 survey respondents (overall response rate, 43%) across the three medication cohorts (PPI, n=1,116/2,624 [43%]; gabapentin, n=40/121 [33%], and diabetes, n=226/461 [49%]). Discussions were less likely if respondents were Black versus White (odds ratio [OR], 0.47; 95% CI, 0.29 to 0.78) and more likely in patients with advanced degrees versus high school or less (OR, 2.39; 95% CI, 1.53 to 3.73) and adequate health literacy (OR, 1.84; 95% CI, 1.16 to 2.92). After further adjusting for general deprescribing attitudes and brochure engagement, researchers reported that discussions were more likely if respondents completed brochure activities (OR, 2.23; 95% CI, 1.39 to 3.59), contacted their clinicians prior to their visits (OR, 2.47; 95% CI, 1.34 to 4.58), or discussed the brochure with family/friends (OR, 1.72; 95% CI, 1.22 to 2.41) or a clinician (OR, 3.18; 95% CI, 2.08 to 4.85).
The authors noted that while patients' general attitudes toward deprescribing were associated with the likelihood of having a deprescribing discussion, this was no longer significant after controlling for brochure-related behaviors. Favorable attitudes toward deprescribing in general did not consistently result in deprescribing actions, emphasizing the importance of tailored, medication-specific interventions, the authors said.
“Notably, 78% of those who had a deprescribing discussion reported initiating that discussion,” they wrote. “This is especially relevant because it suggests that patients raise the topic of deprescribing during healthcare visits, potentially alleviating some provider-level deprescribing barriers (e.g., perceptions that patients are not interested in deprescribing). Regardless of brochure receipt or other intervention, the obligation still remains for clinicians to address deprescribing with their patients. Interventions that are multifaceted and directly address provider-level barriers may augment the effect of patient-centered approaches.”