Design, implementation, and pilot testing of electronic health record deprescribing tools for persons living with dementia in U.S. primary care.

BACKGROUND AND

OBJECTIVES

Electronic health record (EHR) tools are widely used to influence prescribing behaviors. However, the application of EHR tools to deprescribing in older adults, particularly persons living with dementia, is understudied, despite the potential to ameliorate cognitive decline by targeting medications like benzodiazepines and anticholinergics. We explored the design and implementation of EHR-based tools for deprescribing using a multi-phase mixed-methods approach.

RESEARCH DESIGN AND

METHODS

Within a large healthcare system, we first conducted semi-structured qualitative interviews to understand perspectives with primary care providers (PCPs) and care partners. Transcripts were analyzed using immersion/crystallization approaches to generate themes. Second, we designed potential EHR deprescribing tools, including pre-visit provider and patient messages and provider decision support, using an interdisciplinary team based on the interviews. Third, we conducted additional qualitative interviews of drafted tools. Lastly, we conducted pilot testing of the EHR tools with PCPs.

RESULTS

We conducted interviews with 16 care partners of persons living with dementia and 7 PCPs and pilot testing of tools with 12 PCPs. From qualitative interviews, we observed several key themes around the complexity of managing deprescribing, effective framing for deprescribing interventions, health-system limitations influencing deprescribing, and leveraging technology and EHR deprescribing tools. From pilot testing, we observed the acceptability and feasibility of the tools, with salient concerns including the potential for information overload and ensuring adequate personalization.

DISCUSSION AND IMPLICATIONS: This multi-phase implementation study uncovered ways to use EHR tools to overcome deprescribing barriers, with pilot-tested tools that show promise of acceptability and feasibility, warranting further testing.