3.3.1 Deprescribing interventions
All studies implemented deprescribing interventions that targeted either the patient or the clinician. Randomised trials aimed to reduce or cease gabapentinoids dose and evaluated safety. Both randomised trials implemented pharmacological based interventions to patients. (31, 32) One trial evaluated the effect of an electronic decision support tool in deprescribing potentially inappropriate medications within older patients, including gabapentinoids, classed as an “intermediate risk medication”. (31) The electronic decision support tool provided individualised deprescribing reports to treating physicians within three days of patient admission, suggesting opportunities where potentially inappropriate medications could be deprescribed and tapering instructions were indicated. This large trial (n = 6,633 with 925 receiving gabapentinoids) compared the intervention tool, MedSafer, to usual care and whilst focused on prompting the medical team to act on identified opportunities to deprescribe, patients or caregivers were also given educational pamphlets on deprescribing of selected classes of medications (e.g. gabapentinoids, antipsychotics, proton pump inhibitors). The other randomised trial was an industry funded, three arm trial of lorazepam (3 – 4 mg/day) and high dose (450 – 600 mg/day) and low dose pregabalin (150 – 300 mg/day and) to evaluate the prevalence and severity of discontinuation symptoms during the placebo phase in 412 patients with generalised anxiety disorder. (32)
The two observational studies employed education-based, clinician-focussed interventions to reduce gabapentinoid prescribing rates within their respective settings. (27, 28) One study validated the efficacy of a previously developed program, “The 10 Footsteps programme”, in which clinicians underwent bi-weekly health training to improve confidence and motivation when helping manage pain patients, and in particular ‘high-risk’ pain patients. (28) The definition of a ‘high-risk’ pain patient was not stated within the text’s abstract. The other observational study focused on a small cohort of 30 patients and involved the presentation of data and leaflets to general practitioners and nurse prescribers to change clinician prescribing trends and reduce the rate of gabapentinoid prescribing within the practice. (27)