Research Summary

EHR Behavioral Interventions Increase Deprescribing of Inappropriate Medications in Older Adults in Primary Care

Edited by:
Kate Young

Key Highlights

  • Precommitment electronic health record (EHR) prompts increased deprescribing rates by 10.4% compared with usual care.
  • Boostering EHR notifications with follow-up reminders improved deprescribing by 6.5%.
  • No serious adverse events were reported across intervention groups.
  • Behavioral science–informed EHR tools may enhance medication safety in older populations.

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Potentially inappropriate medications remain a persistent concern in geriatric care, with overprescribing contributing to adverse outcomes. A randomized clinical trial found that behavioral science–informed electronic health record (EHR) interventions significantly increased deprescribing rates among older adults compared with usual care.

The study demonstrated that structured EHR notifications designed to influence clinician behavior improved the likelihood of discontinuing or tapering medications such as benzodiazepines, sedative hypnotics, and anticholinergic agents in patients aged 65 years or older.

The trial used a 3-group, parallel, cluster-randomized design involving 201 primary care physicians at an academic center in Massachusetts. Patients eligible for inclusion were aged 65 years or older, had at least one primary care visit during the study period (November 2022 to March 2024), and had been prescribed high-risk medications within the prior 180 days.

Physicians were randomized to usual care or 1 of 2 behavioral interventions embedded in the EHR. The precommitment intervention involved sequential prompts encouraging clinicians to initiate deprescribing discussions during the first visit and follow through at a subsequent visit. The boostering intervention provided an initial notification during the visit followed by a reminder message delivered via the EHR in-basket four weeks later. The primary outcome was deprescribing of at least one targeted medication, defined as discontinuation or tapering documented in the EHR.

Study Findings

Among 1146 patients (mean age 73.6 years; 69.7% female), 32.5% had at least 1 medication deprescribed during a mean follow-up of 289.9 days. Deprescribing occurred in 36.8% of patients in the precommitment group, 34.3% in the boostering group, and 26.8% in the usual care group.

Compared with usual care, the precommitment intervention increased deprescribing likelihood by 40% (relative risk [RR], 1.40; 95% CI, 1.14-1.73), corresponding to an absolute increase of 10.4%. The boostering intervention increased deprescribing by 26% (RR, 1.26; 95% CI, 1.01-1.57), with an absolute increase of 6.5%. No serious adverse events were reported. Mortality rates identified by manual EHR review were 1.4% in the precommitment group, 3.9% in the boostering group, and 1.8% in the usual care group.

Clinical Implications

According to the study authors, the findings suggest that EHR-based interventions incorporating behavioral science strategies can meaningfully improve deprescribing practices among primary care physicians treating older adults. These approaches may offer scalable tools to address medication overuse in routine clinical workflows.

The authors noted limitations including the single academic center setting, which may affect generalizability, and reliance on EHR data, which may not capture all aspects of medication use or deprescribing decisions.

Expert Commentary

“These results support use of EHR tools designed using behavioral science principles to significantly increase rates of deprescribing potentially inappropriate medications used by older adults,” the researchers concluded.

Reference
Lauffenburger JC, Sung M, Glynn RJ, et al. Electronic Health Record Intervention and Deprescribing for Older Adults: A Randomized Clinical Trial. JAMA. Published online January 29, 2026. doi:10.1001/jama.2025.26967