Recommendation #2: Lean into behavior change – or bypass it
In many cases, deprescribing is a type of behavior change more akin to promoting smoking cessation than ordering an X-ray or new medication. It requires engaging with patients to stop a medication to which they may have become psychologically or physically attached and enacting that behavior. It also requires convincing overworked and time-pressed clinicians to engage in conversations that may be difficult and time-consuming and to incorporate these actions into their daily clinical practice.
Thus, it is important for interventions to lean into the science and practice of behavior change. A superb example of this is the brochures developed for and tested in the EMPOWER and D-PRESCRIBE trials, which thoughtfully incorporate principles of health psychology and behavior change.5 Yet, relatively few interventions have followed this lead to incorporate key behavior change elements.6
In a notable exception, under the right conditions health system mandates can offer the opportunity to bypass behavior change. This can arise when systems-level changes reduce or obviate the need for action by patients or clinicians. An example of this is policy changes during early phases of the COVID pandemic which temporarily discontinued non-essential medications in nursing home residents.7Ethical and legal considerations limit such top-down directives, but in selected circumstances they offer novel opportunities for scholarship and improvement.