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.