Deprescribing in Patients Living With Dementia With Caregiver and Provider Nudges

Brigham and Women's Hospital250 enrolled

Overview

The objectives of this study are to demonstrate the feasibility of implementing a deprescribing nudge intervention using pragmatic methods, confirm that outcomes can be feasibly measured and evaluated at scale in a subsequent embedded pragmatic clinical trial (ePCT), and explore representativeness of persons living with dementia and care partners identified.

The PCP nudge will consist of: a 'pre-commitment' EHR nudge triggered when a PCP opens a patient encounter (i.e., prompt to first have a discussion and then later deprescribe) and a brief message within the in-basket prior to upcoming visits including information about their patient. The patient living with dementia (PLWD)/care partner nudge will include an electronic message delivered prior to upcoming visits (in their primary language recorded in the EHR) that includes a recommendation for the PLWD (and care partner, if available) to discuss medications with the PCP at the visit.

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

250

Conditions

Alzheimer Disease Mild Cognitive Impairment Dementia

Interventions

Nudge InterventionBEHAVIORAL

PCPs will receive an enhanced EHR alert (nudge) that triggers when a PCP opens an encounter for an eligible patient living with dementia (PLWD). The nudge will provide information about the risks of continued medication use as well as tips and tools to help providers discuss medication discontinuation with patients and care partners. Additionally, the providers will receive a brief message in their in-basket 10 days before the patient's appointment as a reminder. Eligible PLWD of a randomized PCP will receive the nudge intervention which includes a brief recommendation for the PLWD (and care partner, if available) via the linked patient portal prior to upcoming visits (unless explicitly opted out by the PCP) to discuss medications with the PCP at the visit and link to a general handout about medications, unless explicitly opted out by the PCP. For PLWD without a portal account, the handout will be sent to their mailing address recorded in the EHR.

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

Primary care providers will be the primary unit of identification and randomization. Primary care providers inclusion criteria: * Providers within Brigham and Women's Hospital primary care practices * Having prescribed at least one of the high-risk medications of interest Eligible patients will be identified through this providers within the health care system. Patient inclusion criteria: * At least 65 years of age * Prescribed at least 90 pills of one of the high-risk medications of interest in the last 180 days in the EHR system, which most guidelines consider chronic use, and have a diagnosis of dementia in the EHR.

Locations (1)

Mass General Brigham

Boston, Massachusetts, United States

Outcomes

Primary Outcomes

Composite of the percentage of eligible PCPs or their PLWD/care partners who view or click on information

This will be the primary progression criteria for the study and measured and evaluated separately by patient and provider.

Time frame: On or before the primary care provider visit

Secondary Outcomes

Number of nudges that fire as intended: Fidelity

Number of nudges that fired as intended

Time frame: On the primary care provider visit

Discontinuation or prescribed reduction in medication

Discontinuation or prescribed reduction in dose of at least one high-risk medication of interest within 60 days after the visit.

Time frame: Within 60 days after the primary care provider visit

Data from ClinicalTrials.gov

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