On November 8, 2024, a study was published in JAMA Internal Medicine that evaluated the effectiveness of educational mailings aimed at reducing the prescription of high-risk medications for patients with Alzheimer's disease and related dementias. Conducted by researchers from UMass Chan Medical School, the study highlights the ongoing challenges health plans face in mitigating the risks associated with polypharmacy in elderly populations.

Understanding Polypharmacy

Polypharmacy refers to the simultaneous use of multiple medications by a patient, often resulting in an increased risk of adverse drug reactions, particularly in older adults. Patients with dementia are particularly vulnerable, and careful management of their medications is crucial.

The study, titled D-PRESCRIBE-AD (Developing a Program to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in Elderly with Alzheimer's Disease), involved nearly 13,000 participants from two national health plans. The researchers aimed to understand the impact of mailed educational materials on medication safety.

Study Design and Outcomes

Participants in the study were randomized into three groups:

  • Control Group: Received usual care without any educational mailings.
  • Clinician Group: Only the prescribing clinicians received mailings about the risks of specific drugs.
  • Patient and Caregiver Group: Both the patients and their caregivers, in addition to the clinicians, received the educational mailings.

Despite the intentions of the educational materials, the study found that the mailings had no significant impact on the prescribing patterns of high-risk medications. Principal investigator Dr. Jerry H. Gurwitz emphasized the importance of ongoing reassessment of medication needs for patients with dementia.

Findings and Implications

The following table summarizes key findings from the study:

Group Change in Medication Use Notes
Control Group 20% stopped high-risk medications No additional interventions
Clinician Group 20% stopped high-risk medications Mailings to clinicians
Patient and Caregiver Group 20% stopped high-risk medications Mailings to patients and caregivers

The authors acknowledged that while a significant percentage of individuals stopped taking high-risk medications, the rate was consistent across all groups, suggesting that the mailings did not contribute to changing behaviors.

Challenges in Communication

Dr. Gurwitz noted that health plans often rely on mailings to communicate important information but highlighted the disconnection that often exists in busy clinic settings. Many clinicians may overlook mailings amidst their daily responsibilities, leading to a lack of awareness about the risks associated with certain medications.

“The bigger implications of our study relate to how health plans communicate with their members ... and they have to figure out a better way.” – Dr. Jerry H. Gurwitz

Future Research Directions

Despite the study's negative findings, Dr. Gurwitz underscored the necessity for continued research in effective communication strategies for risk reduction in prescribing practices. In collaboration with national health plans, the research team is developing novel solutions. Key research directions include:

  • Direct Involvement of Pharmacists: Studies from Canada suggest pharmacist involvement might enhance the effectiveness of educational interventions.
  • Alternative Communication Approaches: Exploring more engaging and interactive methods of communication that resonate with both patients and providers.
  • Further Evaluation of Medication Safety: Continued examination of the impact of high-risk medications on older adults with dementia and devising strategies to mitigate risks.

This study serves as a starting point for future investigations on effective methods of reducing high-risk medications among patients with Alzheimer's disease.

References

[1] Gurwitz, J. H., et al. (2024). High-Risk Medications in Persons Living With Dementia, JAMA Internal Medicine.
[2] Lifespan.io