Research Studies

Members and affiliates of the Canadian Medication Appropriateness and Deprescribing Network are leading and participating in local, national, and international research.

This page presents just a few examples of high-impact research studies informing us on ways to improve the way we use medications, to promote health and reduce harm. Click on the links below for more information!

To learn more about the researchers leading these studies and other researchers affiliated with the network, click here.

Are you interested in having your research in medication appropriateness and deprescribing featured on this webpage? Want to become a research affiliate? Contact us to learn more or share your success.

A web-based application to prevent adverse drug events (ActionADE)

About ActionADE

One in nine emergency department visits are due to an adverse drug event, of which one third are repeat events. ActionADE's goal is to reduce adverse drug events by preventing unintentional re-exposures to culprit medications. ActionADE does this, by allowing clinicians to document adverse drug events in a user-friendly and rapid manner. ActionADE shares this information with PharmaNet (British Columbia’s provincial medication dispensing database), community pharmacies, and other computer information systems to inform the patient’s circle of care. Community pharmacists receive an alert if they attempt to re-dispense a culprit or same-class medication.

Study results

The study team evaluated the technology using a randomized controlled trial design. Trial monitoring indicated that 34% of patients with an adverse drug event report shared with PharmaNet sought a re-dispensation of the harmful medication. Alerts in community pharmacies prevented a re-dispensation in 32% of cases. If implemented across BC alone, ActionADE has the potential to avoid $50 million in repeat adverse drug event-related emergency department visits and hospital admissions every year.

For more information, visit the ActionADE website and Linkedin page.

Policies for deprescribing sedative-hypnotics: an international review

Study objective

To examine and compare the outcomes of global jurisdictional-wide policies on the reduction of sedative-hypnotic use among community-dwelling older adults.

Study results

Targeted health promotion and public awareness campaigns were found to be the safest policies to deprescribe sedative-hypnotic medications. Policies that monitored prescribing practices or restricted reimbursement for sedative-hypnotics, on the other hand, were associated with increased out-of-pocket spending by patients, substitutions with other potentially inappropriate medications and increased administrative burden for prescribers. Financial incentives for physicians were ineffective in reducing sedative-hypnotic prescriptions.

For the full publication, click here.

A rapid realist review of factors influencing the effects of policies and interventions to promote the appropriate use of medicines in high-income countries

This publication can provide policy-makers with insights on the contextual factors and mechanisms that support successful interventions promoting appropriate medication use. Among these, policy-related factors underpinning successful interventions included patient and provider involvement, central coordination through national agencies dedicated to medicine policies, and the establishment of an explicit and integrated medicine policy strategy.

For the full rapid realist review, click here.

TAPERING: Trial Applying Policy to Eliminate or Reduce Inappropriate Narcotics in the General Population

Study objective

Evaluate the effectiveness of a government-led, direct-to-patient educational intervention to reduce opioid use in Manitoba.

Study results

Compared to usual care, the educational brochures reduced mortality and modestly reduced opioid doses, but did not have an effect on the number of people stopping their opioid medication. Differences in deprescribing efficacy between TAPERING and previous trials such as EMPOWER can be explained by two factors: 1) the brochures being mailed by the Manitoba government, as opposed to a trusted healthcare provider; 2) the possible higher resistance to opioid deprescribing due to greater dependence on opioids compared to other drug classes.

Future directions: Implementing a synergistic approach to health education and behavioural interventions, by targeting both patients and prescribers.

For the full publication, click here.

YAWNS NB: Your Answers When Needing Sleep in New Brunswick

About the YAWNS NB trial

Benzodiazepine receptor agonists (BZRAs) are commonly prescribed for insomnia, particularly among older adults, but long-term use carries significant risk. In the The Your Answers When Needing Sleep in New Brunswick (YAWNSNB) study, researchers sought to evaluate the impact of direct-to-patient, mailed behavior change interventions on reducing BZRA use and improving sleep outcomes in older adults with chronic insomnia. The Sleepwell mailed behavior change package consisted of a cover letter and 2 booklets ("How to Stop Sleeping Pills" and "How to Get Your Sleep Back"). The study involved adults aged 65 and older who had been using BZRAs for an average of 11 years. 

Study Results

Results of the YAWNS NB randomized clinical trial show that, as a simple, scalable, direct-to-patient educational intervention substantially reduced BZRA use and improved sleep outcomes. It could be implemented to transform insomnia care for older adults at the population level.

For the full publication, click here.

Learn more about Sleepwell by clicking here.

Pharmacist-led intervention using a pharmaceutical opinion to reduce potentially inappropriate prescriptions in older adults (D-PRESCRIBE)

About D-PRESCRIBE

The D-PRESCRIBE cluster randomized trial conducted in Quebec, Canada, aimed to investigate the impact of community pharmacists’ intervention on both patients and prescribers to reduce inappropriate prescriptions. Pharmacists in the intervention group sent patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion to recommend deprescribing. The control group received usual care.

Study results

At 6 months, in the intervention vs control groups, deprescribing of inappropriate medication occurred among 43% of sedative hypnotic users (benzodiazepine and z-drugs) vs 9%, 58% of non-steroidal anti-inflammatory medications users vs 22%, and 31% of glyburide users vs 14%. As a result, the pharmacist-led educational intervention compared with usual care led to greater reduction of inappropriate prescriptions.

Read more about the D-PRESCRIBE trial here.

Deprescribing guidelines supporting clinical decisions (deprescribing.org)

About Deprescribing.org

Since its creation now more than 10 years ago, the deprescribing.org research team created 5 medication-class focused deprescribing clinical practice guidelines to support deprescribing decisions. The guidelines have been endorsed by the College of Family Physicians of Canada and the National Institute for Health and Care Excellence (UK) among others. They have been modified and translated 26 times for use around the globe.

Ongoing research using the guidelines

The team also has worked to bring deprescribing into clinical practice using practitioner- and patient-focused implementation strategies. Deprescribing.org been awarded a 4-year funding from the Canadian Institutes of Health Research to support a multi-method study to address diabetes over-treatment in long-term care homes using the deprescribing guidelines and associated tools.

Visit the deprescribing.org website for more information.

Electronic decision support for deprescribing (MedSafer)

About MedSafer

MedSafer is an electronic decision support tool that helps guide health professionals through safe and effective deprescribing. The MedSafer study published in JAMA Internal Medicine in 2022 aimed to determine whether electronic decision support increases deprescribing of potentially inappropriate medications and reduce adverse drug events within 30 days of discharge from hospital. The study recruited 5698 patients aged 65 years and older from across Canada who were taking 5 or more daily medications at hospital admission. Clusters of hospitals were randomized to the intervention (individualized deprescribing reports generated by MedSafer and provided to the treating team) or usual care.

Study results

The absolute rate of deprescribing (measured at 30-days post-hospital discharge) increased by more than 20% in the intervention arm, without any increase in adverse drug events, concluding electronic decision support for deprescribing was safe and effective.

Visit the MedSafer website for more information.

Call for participants

The MedSafer study is currently recruiting adults age 60 and over to help improve their new App which aims to make medication reviews more accessible and effective for patients and their healthcare professionals. Learn more here! (Updated February 2024.)

About the Deprescribing in Hemodialysis study

Patients treated with dialysis are commonly prescribed multiple medications, some of which are potentially inappropriate medications (PIMs). PIMs can increase a patient’s pill burden and are associated with an increased risk of harm (some examples include falls, fractures, and hospitalization). Deprescribing is a proposed solution that aims to highlight medications that can be stopped, reduced, or switched to a safer option, under supervision of a health care provider. This study aimed to determine if a quality improvement intervention in the dialysis unit could increase deprescribing compared to usual care.

The study took place in 2 outpatient hemodialysis units where usual care involves nurses and nephrologists performing medication reviews twice a year. The intervention was a deprescribing report that was generated with the help of a software tool called MedSafer, along with brochures for patients with information on PIMs they were taking.

Study results

In the intervention unit, the number of patients who had a medication safely deprescribed was increased by 36.6% more than on the control unit. Although the study was small, a future larger study in dialysis patients might show that a computer software such as MedSafer can prevent harmful complications from taking too many medications.

Visit the publication for more information.

Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study

Partnership with government to reduce inappropriate medication use (SaferMedsNL)

About SaferMedsNL

SaferMedsNL is a collaboration between patients, pharmacists, doctors, and nurses all working together to make sure medications are continued when necessary and stopped when they are no longer needed. This project received funding from the Government of Newfoundland and Labrador (NL). It aimed to promote the safe reduction or discontinuation of certain classes of drugs over three years. Participants were residents of NL who are receiving long term prescriptions including those living in long-term care. Under this program, the government reimbursed pharmacies for an initial and follow-up deprescribing consultation.

Study results

To be published soon. Visit the SaferMedsNL website for more information.

About Sleepwell

Sleepwell aims to transform insomnia care by reducing sedative-hypnotic use and increasing access and use of effective, evidence-based, first-line behavioural interventions including cognitive-behavioural therapy for insomnia (CBT-i).

As part of the YAWNS NB 3-arm, 6-month follow-up randomized controlled trial, Sleepwell mailed information packages were sent to older adults in New Brunswick taking sleeping pills. This intervention was compared to a send-out of EMPOWER brochures, or treatment-as-usual. The primary outcome of the study was discontinuation of chronically used sleeping pills by older adults without switching to other sedating medications or substances. Other outcomes of interest included access and use of CBT-i techniques for improving sleep and sleep outcomes.

Study results

The findings of the study, which will be published in 2023, were encouraging and have stimulated follow-up investigations and discussions with decision makers.

Visit the Sleepwell website for more information.

Better sleep through evidence-based interventions (Sleepwell)

GABA-WHY Trial: Direct-to-Consumer Educational Brochures to Promote Gabapentinoid Deprescribing in Older Adults

About the GABA-WHY Trial

Gabapentinoids are a class of antiseizure medications that include pregabalin and gabapentin. Despite an increased risk of adverse effects and death, particularly when taken in combination with opioids, gabapentinoids are among the 10 most prescribed drugs in North America and are mostly prescribed inappropriately. In a new article published in the Journal of American Medical Association (JAMA) Internal Medicine, a team of authors led by Dr. Emily McDonald (network director) sought to evaluate the effect of patient educational brochures as a low-cost, scalable, educational intervention to reduce the inappropriate use of gabapentinoids in older adults.  Participants were individuals aged 60 and older who were receiving a gabapentinoid at the time of hospitalization for reasons other than seizures. Patients received a brochure with information on the potential risks of their gabapentinoid medication, non-pharmacological alternatives and a proposed tapering schedule.   

Study results

After 8 weeks, the group who had received the brochures reported an absolute 13.3% increase in the rate of gabapentinoid deprescribing compared to usual care (21.1% versus 9.9%, respectively; number needed to treat = 8). Importantly, deprescribing these medications did not increase the concurrent use or initiation of new pain medications, or the level of pain reported by patients. 

For the full publication, click here.

Reducing potentially inappropriate polypharmacy at a national and international level: the impact of deprescribing networks

About the article

Over the past decade, polypharmacy has increased dramatically, placing patients at risk of measurable harms including falls, fractures, cognitive impairment, and death. The associated costs for patients and the healthcare system alike are massive and contribute substantially to low-value health care. Establishing a network to address polypharmacy can help overcome barriers by connecting individuals with an interest and expertise in deprescribing, and can act as an important source of motivation and resources. Over the past decade, several deprescribing networks were launched to help tackle polypharmacy, with evidence of individual and collective impact. A network approach has several advantages; it can spark interest, ideas and enthusiasm through information sharing, meetings and conversations with the public, providers, and other key stakeholders. 

Study results

Networks have created links between people who lead existing and/or budding deprescribing practices and policy initiatives, have influenced people with a shared passion for deprescribing, and facilitated sharing of intellectual capital and tools to take initiatives further and strengthen impact.

 For the full publication, click here.

The cost of potentially inappropriate medications (PIMS) for older adults in Canada

About the Cost of PIMS study

Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described. This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. 

Study results

Canadians spent $1 billion on PIMs for older adults in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). Exposure to most categories of PIMs decreased, except for exposures to gabapentinoids, proton pump inhibitors, and antipsychotics, which have all increased between 2013 and 2021. In addition to decreased exposures to most PIMs, cost savings were also attributed to greater availability of generics and reductions in drug costs. 
In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).

While expenditures on PIMs have declined in Canada, the overall cost remains high and prescribing of some harmful medications are on the rise. Targeted, scalable interventions are needed to promote the appropriate use of these medications.

For the full publication, click here.