A recent study led by researchers at UMass Chan Medical School reveals that mailing educational materials to Alzheimer’s patients, caregivers, and doctors had no impact on reducing risky drug prescriptions.
Published in JAMA Internal Medicine, the study aimed to address the dangers of prescribing certain high-risk medications to individuals with Alzheimer’s disease or other dementias, as these patients are more vulnerable to side effects from specific drugs.
Older adults with dementia are often prescribed multiple medications, which increases the risks of adverse effects.
This study, led by Dr. Jerry H. Gurwitz, professor of primary care medicine and an expert in geriatrics, aimed to reduce prescriptions of antipsychotics, sedative-hypnotics, and strong anticholinergics (like some bladder-control drugs) by informing patients and doctors of these risks.
Known as D-PRESCRIBE-AD (Developing a Program to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in Elderly with Alzheimer’s Disease), the study was a large-scale trial involving nearly 13,000 people with dementia enrolled in two national health plans.
Participants were divided into three groups: one where only the prescribing doctor received a mailing about the risks of these drugs, another where the doctor, patient, and caregiver all received mailings, and a third group that received no mailings and continued usual care.
Dr. Gurwitz explained that mailings are still commonly used by health plans to inform doctors and patients about important health issues.
However, he noted that letters to busy clinicians often arrive “out of context” and are easily overlooked.
There was hope that patients or their caregivers would bring the information to their doctors to discuss safer treatment options, but this did not happen.
Although roughly one in five patients who received mailings or whose providers received them stopped taking the risky drugs, the same percentage of patients who received no mailings also stopped, highlighting that the letters made no real difference.
Despite the outcome, Dr. Gurwitz believes there are valuable lessons in these results. Health plans often send out information without knowing if it has any impact, especially for significant issues like medication safety. “It’s an important challenge, and they need to figure out a better way,” he said.
Interestingly, similar studies in Canada, which included pharmacists working directly with patients, have shown better results with educational efforts. These differences suggest that more direct involvement of healthcare providers, rather than simple mailings, may be necessary for effective change.
Dr. Gurwitz and his team are continuing their research to find new ways to address unsafe prescribing practices in dementia care.
Working with national health plans, they hope to develop more effective strategies for reducing risky medications for vulnerable older adults.
“We can’t stop trying,” Gurwitz emphasizes, recognizing the importance of finding solutions that protect the health and safety of people living with dementia.
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