# Engaging Patients to Promote Deprescribing

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2022 · —

## Abstract

Background – Despite multiple provider- and system-level interventions to reduce potentially inappropriate
medications (PIMs), many Veterans are still prescribed drugs that provide little benefit, placing them at
unnecessary risk of adverse drug events (ADEs). One mechanism to reduce PIMs is through deprescribing, a
de-implementation-based approach to thoughtfully discontinue a medication a patient is currently prescribed.
 Many Choosing Wisely recommendations address PIMs. Specifically, proton pump inhibitors (PPIs), a
medicine used to reduce gastric acid, should be de-escalated to the lowest dose necessary to provide relief.
Many older patients with diabetes are over-controlled, with blood sugar levels lower than recommended, yet
remain on multiple diabetes medicines and may be able to use fewer medicines. These patients are also at
higher risk of low blood sugar from insulin and sulfonylureas, and should have limited use of these agents.
Finally, gabapentin is often used off-label to treat pain, with greatly increased use over the past several years.
 There are many barriers to deprescribing PIMs. Many interventions solely target the prescribing provider.
Although some believe providers have primary responsibility for deprescribing, patient initiation of
discontinuation conversations can effectively facilitate deprescribing. In a single-site pilot study, we
successfully reduced PIMs by engaging VA Primary Care patients by providing them with Veteran-centric
EMPOWER (“Eliminating Medications through Patient Ownership of End Results”) brochures. However, it is
not known if this approach will be as successful for Veterans with other chronic conditions or at non-pilot sites.
Aims – We propose three aims. 1) Examine the impact of a patient-centered intervention to change provider
prescribing (the primary outcome), as determined by the frequency with which medications are either
deprescribed or de-escalated. 2) Examine the effect of a patient-centered intervention on engaging patients,
via post-visit surveys of Veterans’ interaction with the brochures and their influence on deprescribing
discussions and deprescribing. 3) Using qualitative methods, identify key organizational contextual factors
related to intervention fidelity, feasibility, acceptability, and appropriateness to support future implementation.
Methods and Innovation – We propose a multisite quasi-experimental trial using a Hybrid Type I
Effectiveness-Implementation design of providing EMPOWER brochures directly to Veterans who may be
deprescribing candidates for three cohorts of PIMs (PPIs, diabetes medications, and gabapentin). We will mail
brochures in advance of scheduled primary care visits, unlike distribution methods used in other studies. Our
primary outcome will be the composite of deprescribing and de-escalation of target medications, identified in
pharmacy dispensing records of the Corporate Data Warehouse (Aim 1). Mail-based surveys sent after the
scheduled primary care visi...

## Key facts

- **NIH application ID:** 10359059
- **Project number:** 5I01HX002798-03
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Amy Linsky
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-03-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10359059

## Citation

> US National Institutes of Health, RePORTER application 10359059, Engaging Patients to Promote Deprescribing (5I01HX002798-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10359059. Licensed CC0.

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