Trial Outcomes & Findings for A Program to Reduce Inappropriate Medications Among Older Adults With Alzheimer's Disease (NCT NCT05147428)

Patients with 1 year of health plan coverage who met the following criteria: 1\) AD/ADRD, defined as either presence of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for AD/ADRD associated with 2 different claims or as 2 dispensings for an agent used for AD in the 365 days prior to or on cohort entry; (2) age 50 or older; and (3) a dispensing of any of the 3 targeted drug classes in the 3 months prior to or on cohort entry.

To address the potential for within-prescriber contamination, only 1 randomly selected eligible patient was randomized per prescribing clinician.

A Program to Reduce Inappropriate Medications Among Older Adults With Alzheimer's Disease

The primary outcome will be defined as dispensing of the targeted inappropriate prescription class from day 91 to day 270 during the 6 months observation period following receipt of intervention, or days 91-270.

Dose reduction was measured as the percentage of patients who achieved a reduction in the patient-specific and medication-specific mean daily dose of the medication targeted for deprescribing of 50% or more during the 6-month study observation period compared with the mean daily dose for the 6-month period immediately preceding the date of mailing of the educational materials. Mean daily dose was calculated using days of supply, dispensed quantity, and unit strength of all dispensings occurring during the 6-month period of interest (either the 6-month study observation period or the 6-month period immediately preceding the date of the mailing).

Polypharmacy was defined as being dispensed 5 or more unique prescription medications, assessed on the last day of the 6-month study observation period. Polypharmacy was based on medications administered by any route (including topical or ocular medications) and included AD medications and the 3 medication classes targeted for deprescribing. A combination drug was considered a single medication for the purpose of this analysis.

We assessed the occurrence of any ambulatory encounter over the 6-month observation period.

We assessed all-cause inpatient mortality in all study participants (n=12,787) during the 6-month study observation period.

Switching of agents within the following targeted drug classes: sedative/ hypnotics, antipsychotics, highly anticholinergic agents.

We assessed the occurrence of any emergency department encounters over the 6-month observation period.

We assessed the occurrence of any hospitalizations over the 6-month observation period.

We assessed the occurrence of any non-acute institutional admissions over the 6-month observation period.