Using Real-World Data and Pharmacoepidemiologic Methods to Advance the Science of Deprescribing Research

Background: Deprescribing is a healthcare provider-supervised process in which certain medication use is reduced or stopped in order to minimize potential medication-related harms, remove medications that are no longer beneficial, and improve patient outcomes. However, rigorous evidence on the benefits and safety of deprescribing, especially among high risk patients such as older adults, is scarce. Randomized control trials (RCTs) on deprescribing are limited by small sample sizes, restricted generalizability, patients' and caregivers' reluctance to participate, and substantial attrition. Observational studies using real-world data (RWD) sources that document what happens in routine clinical care are critical to overcoming these limitations because they can provide evidence on deprescribing that is more generalizable and can help inform future RCTs.

Objectives: To discuss how RWD sources such as claims, electronic health records (EHR), registries, and patient-reported data across international settings may be leveraged to understand deprescribing patterns and associated outcomes.

Description: Dr. Daniela Moga will introduce the session and the potential role of deprescribing in optimizing medication use (5 min). Each speaker will then provide an example of a deprescribing study conducted using RWD and discuss the strengths and challenges of their approach. They will also share what steps or methodological innovations they envision will improve the quality of future deprescribing research conducted using RWD. Dr. Joshua Niznik will present on studying deprescribing using Medicare insurance claims data and linked with nursing home data as well as data from the Department of Veterans Affairs (15 min). Dr. Shahar Shmuel will present on using linked Medicare claims and EHR data to improve claims-based deprescribing research (10 min). Dr. Julie Lauffenburger will present on how EHR data can be leveraged to conduct randomized pragmatic trials of deprescribing interventions (15 min). Dr. Lucas Morin will present recent examples of deprescribing studies based on Scandinavian registries (15 min). Dr. Danijela Gnjidic will present on how patient and caregiver-reported data have been used to study deprescribing in Australia and internationally (15 min). Afterwards, a Q&A session will be moderated by Drs. Xiaojuan Li and Kaley Hayes (15 min). This session was endorsed by the geriatric pharmacoepidemiology SIG.