In the realm of primary care, the challenge of deprescribing medications prescribed for cardiovascular risk factors and diabetes remains significant. Despite being included in clinical guidelines, the actual implementation of deprescribing practices is often fraught with difficulties. To address this, a novel blended training program aimed at equipping healthcare providers with the skills necessary to initiate and carry out effective deprescribing consultations is being studied in the Netherlands.
Study Design and Methods
A cluster-randomized trial will be conducted, involving local pharmacy-general practice teams. These teams will be divided into two groups: one will continue with the usual clinical medication reviews, while the other will receive the CO-DEPRESCRIBE training program. This intervention targets patients aged 75 years and older who are using specific cardiometabolic medications, such as diabetes drugs, antihypertensives, and statins, and who are eligible for a medication review.
The CO-DEPRESCRIBE program is built on prior research and incorporates models of patient-centered communication and shared decision-making. It includes five training modules and supportive tools designed to enhance the healthcare provider’s ability to deprescribe safely and effectively.
Outcome Measures and Data Collection
The primary measure of success for this study is the percentage of patients who have at least one cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision-making, the communication skills of healthcare providers, health and medication-related outcomes, attitudes towards deprescribing, the complexity of medication regimens, and health-related quality of life. Safety and cost parameters will also be monitored.
A total of 167 patients per study arm are required for the final intention-to-treat analysis, with the expectation that 40 teams will recruit 10 patients each. Assessments will be conducted at baseline and six months following the intervention, encompassing a process evaluation and a cost-effectiveness analysis.
Key Inferences
– Blended training programs can significantly improve healthcare providers’ skills in deprescribing.
– Patient-centered communication and shared decision-making are critical for successful deprescribing.
– Comprehensive evaluation of training programs is essential for sustainable implementation in primary care.
– Monitoring both safety and cost parameters is crucial in evaluating the effectiveness of deprescribing interventions.
The hypothesis driving this study is that the CO-DEPRESCRIBE training program will result in more proactive and patient-centered deprescribing practices for cardiometabolic medications. Through thorough evaluation, this program aims to enhance the knowledge necessary for the sustainable implementation of deprescribing in primary care settings.
Original Article: BMC Prim Care. 2024 Jun 11;25(1):210. doi: 10.1186/s12875-024-02465-7.
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