Deprescribing

Grand Rounds April 10, 2026: Impact of Behavioral Science-Based Electronic Health Record Tools on Deprescribing for Older Adults (Julie Lauffenburger, PharmD, PhD)

Posted on by terren.green@duke.edu

Speaker

Julie Lauffenburger, PharmD, PhD
Associate Professor of Medicine
Brigham and Women’s Hospital and Harvard Medical School

Keywords

Adaptive trial design; Behavioral science; Deprescribing; electronic health record; EHR; Inappropriate prescribing; NUDGE-EHR; Overprescribing.

Key Points

  • Older adults are often overprescribed medications or prescribed potentially inappropriate medications like benzodiazepines, non-benzodiazepine sedative hypnotics, or strongly anticholinergic medications with long-term use associated with a 30% increased risk of hospitalizations and falls.
  • Medication management or optimization in older adults is often difficult due to a tendency to maintain the status quo, time constraints, patient preference, or diffusion of responsibility, and existing interventions for medication management are highly resource intensive.
  • Behavioral science techniques employed in the NUDGE-EHR and NUDGE-HER-2 trials may enhance the effectiveness of electronic health record (EHR) tools to alert clinicians to inappropriate medications during patient visits.
  • NUDGE-EHR was a 16 arm two-stage adaptive pragmatic trial among 216 primary care providers and older adult patients conducted from October 2020 to August 2022 examining 14 promising EHR tools using 9 different behavioral principles with deprescribing as a primary outcome.
  • The 2 most promising tools were included in the second 3 parallel arm pragmatic trial, NUDGE-EHR-2, in a different health system from November 2022 to March 2024. EHR tools used pop-up windows to suggest deprescribing. The study provided a set of helpful options to providers including a tapering algorithm, instructions for patients, orders for alternative medications, and referrals to behavioral health providers to make this process faster and easier.
  • Deprescribing increased by 6.5% to 10.4% over usual care. Active discontinuation by primary care providers appeared to drive the results.

Discussion Themes

The adaptive trial design of the first NUDGE-EHR study helped inform the more traditional confirmation trial NUDGE-EHR-2.

The way EHR tools are used varies widely from provider to provider. Tools may be adapted over time so the tool works best for the individual provider.

 

Read more about the NUDGE-EHR study.

 

April 8, 2026: Behavioral Science-Based Electronic Health Record Tools, in This Week’s Rethinking Clinical Trials Grand Rounds

Posted on by Sophia Ramirez

In this Friday’s Rethinking Clinical Trials Grand Rounds, Julie Lauffenburger of Harvard Medical School will present on the “Impact of Behavioral Science-Based Electronic Health Record Tools on Deprescribing for Older Adults.”

The Grand Rounds session will be held on Friday, April 10, 2026, at 1:00 pm eastern.

Lauffenburger is an associate professor of medicine at Brigham and Women’s Hospital and Harvard Medical School.

Join the online meeting

Add to your calendar:
Google
iCal
Outlook

Or join the Grand Rounds mailing list to receive calendar invitations.

June 3, 2022: Results of the MedSafer Study: Electronic Decision Support for Deprescribing in Hospitalized Older Adults (Emily G. McDonald MDCM, MSc, FRCPC)

Posted on by Elizabeth Mccamic

Speaker

Emily G. McDonald MDCM, MSc, FRCPC
Scientific Director; Canadian Deprescribing Network
Associate Professor of Medicine; McGill University

 

 

Keywords

MedSafer, Deprescribing

Key Points

  • Overmedicating seniors is a worldwide problem. Seniors are prescribed an average of 7 different drug classes, and 25 percent of older people are prescribed 10 or more drug classes. More drugs are prescribed to people in rural regions, low-income neighborhoods or residing in long-term care.
  • Polypharmacy can result in adverse drug events. There are more adults seeking medical treatment due to adverse drug events, resulting in more hospitalization, unnecessary hospital costs, and early death. A person’s risk of increased adverse drug event increases by 10 percent for each drug.
  • One solution is deprescribing, looking at an accurate list of medications, looking at the indication of each medication and thinking through the present and future risks/benefits, and developing a program to taper or change medications, minimizing side effects and maximizing benefits.
  • MedSafer was built to identify deprescribing opportunities, facilitate Rx checkup, cross-reference medical conditions, lab values, life expectancy, and frailty with the medication list, and integrate for use with the electronic health record.
  • In 2015, the MedSafer Pilot was conducted as a controlled trial in older adults in 3 sites/4 hospitals in Quebec and Ontario. The pilot found MedSafer had a large impact on deprescribing, especially for antipsychotics.
  • In 2015-2016 a larger, randomized trial was launched to see what effect MedSafer has on adverse drug events. For this trial 11 hospitals were divided into 3 clusters, representing different regions of Canada. Close to 6,000 patients were enrolled. Reports that were provided to medical providers were found to increase deprescribing across the board. There was no significant difference in adverse drug events within 30 days of discharge.

Discussion Themes

– To scale up these types of interventions, we need government and patient support to integrate into existing interfaces for long-term care.

– Future studies might follow patients for a longer period of time, have more pharmacy involvement in adjudication, and include more clusters.

Read more about MedSafer.

Tags

#pctGR, @Collaboratory1