Electronic Decision Support for Deprescribing in Older Adults Living in Long-Term Care: A Stepped-Wedge Cluster Randomized Trial
Abstract
Importance: Potentially inappropriate prescribing (PIP) is common, costly, and harmful. Deprescribing potentially inappropriate medications (PIMs) is a priority for improving the health outcomes of older adults. PIP is especially common in long-term care homes, with up to 88% of residents affected.
Objective: To assess the efficacy of electronic decision support for deprescribing in long-term care.
Design, setting, and participants: This stepped-wedge cluster randomized trial took place from August 1, 2021, to October 31, 2022, during the COVID-19 pandemic. The study assessed older adults residing in 1 of 5 long-term care homes in New Brunswick, Canada, at the start of the study who were prescribed 1 or more PIMs. The 5 long-term care homes were divided into 3 clusters. All clusters spent at least 3 months in a control phase; every 3 months a cluster was randomized to enter the intervention phase. Data analysis was performed from October 15, 2023, to March 24, 2025.
Interventions: Electronically generated, individualized reports that contained prioritized opportunities for deprescribing in older adults were paired with preexisting quarterly medication reviews. Deprescribing reports were accessed through a secure viewer.
Main outcomes and measures: The primary outcome was the proportion of residents with 1 or more PIMs deprescribed in the control phase vs intervention measured every 3 months after a medication review. For the primary outcome, an adjusted odds ratio (AOR) was…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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