SAN ANTONIO — An intervention in which Canadian pharmacists faxed their opinions about benzodiazepine use in older adults to physicians resulted in twice the number of deprescriptions as patient education alone, according to early data from the randomized controlled D-PRESCRIBE trial.

“In Canada, about two-thirds of those aged 65 and up take at least five medications daily, and one-quarter take at least 10 medications,” said investigator Philippe Martin, a PhD student in pharmaceutical sciences at Université de Montréal.

Appropriate medication use is a top target in geriatrics, and healthcare in general. One of the main concerns is potential adverse effects, which are compounded by the polypharmacy common in older adults.

The focus of D-PRESCRIBE was benzodiazepines “because they are the most prominent inappropriate prescription, even though the side effects have been known for a long time. And it is one of the hardest classes of drug to deprescribe,” Martin explained here at the American Geriatrics Society 2017 Annual Scientific Meeting.

The EMPOWER intervention involved an eight-page brochure, written at a low-literacy level in large font. In addition to risks and harms, the brochure suggested alternative drugs and offered a tapering-off schedule, designed to encourage patients to discuss discontinuation with a pharmacist or healthcare provider.

Six months after the intervention, a discontinuation rate of 27% was achieved, reported Martin, who was one of the EMPOWER investigators.

However, the researchers discovered that there was often resistance from physicians when patients approached them with the information, because physicians often were unaware of the risks or did not have an alternative drug to prescribe, Martin explained.

For that reason, he and his colleagues developed the D-PRESCRIBE trial, which added an evidence-based opinion from a pharmacist faxed to the patient’s physician.

Participating pharmacists still gave patients the educational brochure used in the EMPOWER trial, but they also faxed evidenced-based pharmaceutical opinions to prescribers outlining the potential risks of benzodiazepines and encouraging deprescription.

Patients, pharmacists, physicians, and evaluators were blinded to the research.

Physicians could quickly change a prescription by writing their license number on the fax, signing it, and returning it to the pharmacist.