An attempt to encourage deprescribing of drugs linked to dementia risk through electronic health record nudges failed to win the attention of physicians and patients, according to a new study.
Investigators aimed to reduce rates of anticholinergic prescriptions through provider and patient-based EHR alerts. These nudges were designed to trigger staff at 10 primary care clinics to play an educational video for patients in preparation for one-on-one clinician visits. But engagement with the alerts was too low to determine any effect, reported Noll Campbell, PharmD, MS, of the Indiana University Center for Aging Research at Regenstrief Institute and Purdue University College of Pharmacy.
In fact, fully 85% of alerts to providers and 95% of alerts to medical assistants went unread during the course of the study, Noll said.
“Deprescribing is very complex and rarely prioritized over common medical problems during visits with primary care providers,” Noll explained.
Improving the nudges or policies that discourage the anticholinergic drugs’ use may be necessary, he and his colleagues concluded.
“One option going forward is to experiment with different design approaches in EMR-based nudges,” Campbell said. “Alternatively, a shift towards human-based interventions that can manage the complexity of deprescribing activities may be more effective at deprescribing high-risk anticholinergic medications,” he added.
Anticholinergics are drugs that block processes in the brain tied to memory, alertness and planning skills. Despite their link to dementia, they are used by about 1 in 4 older adults each year and are prescribed for many conditions common in older adults, including depression, urinary incontinence, irritable bowel syndrome and Parkinson’s disease. They include tricyclic antidepressants, first-generation antihistamines (such as Benadryl), and overactive bladder antimuscarinics.
Noll and his research colleagues currently are conducting what they say is the first clinical trial to determine whether the drugs cause cognitive decline. They’ll also look at whether deprescribing can be done safely.
The EHR alerts study was published in the Journal of the American Geriatrics Society.