Deprescribing Super Special Part II: Podcast with Elizabeth Bayliss, Ariel Green, and Kevin McConeghy

A year ago we did our first “Deprescribing Super Special”.  Today we are coming back for more (or less given the content), talking about the following articles with their lead authors:

First up, we talk with Ariel Green about her article in JAMA Network on preferred phrases a clinician may use to explain why they should reduce or stop the medication.   My take home from this is that while the most preferred explanation for deprescribing statins and sedative-hypnotics is one focused on the risk of side effects, we also need to individualize it to the patient and the medication that they are taking.

Next up, we chat with Liz Bayliss about her JAMA IM article that studied whether increasing awareness about deprescribing prior to primary care visits can reduce the use of potentially inappropriate long-term medications for individuals with cognitive impairment.  While the study was largely negative, it does bring up important implications about how we should think about deprescribing in older adults (added bonus too - all of the resources used in the study can be found on the US Deprescribing Research Network website).

Lastly, we talk with Kevin McConeghy about one deprescribing intervention that was hugely successful, although somewhat atypical.  Kevin’s study looks at a period of time in the COVID pandemic when a large multistate nursing home provider created a “nonessential medication on hold” (NEMOH) policy in order to conserve critical nursing resources and PPE, and to limit exposure risk for residents by reducing unnecessary contact.  Although the policy was not originally envisioned as a deprescribing intervention, 54% of held medications were discontinued.  That’s huge!  While it’s unlikely this will be repeated, we talk about lessons we can learn from this natural experiment.