EMPOWER (Eliminating Medications through Patient OWnership of End Results)
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Share PrintEMPOWER is a direct-to-consumer communication tool intended to empower older adults to decrease or stop use of high-risk medications after consulting with their healthcare team.
Origin:
February 2022, VISN-4
Adoptions:
5 successful, 2 in-progress, 1 unsuccessful
Partners:
Quality Enhancement Research Initiative
Recent Updates
Overview
The problem
Medications that affect the sensorium are a high-yield target for reducing harm in older adults because they are a common reason for adverse events such as falls, fractures, and overdoses, all of which lead to substantially higher health care utilization and worse patient outcomes.
Links
- Central Nervous System-Active Prescriptions in Older Veterans: Trends in Prevalence, Prescribers, and High-risk Populations Peer Reviewed Journal Article
The solution
EMPOWER is a direct-to-consumer intervention in which a booklet is mailed to older adults who are receiving high-risk medications on a chronic basis. Patients are identified from prescription records or dashboards, and booklets are personalized based on the drug(s) prescribed.
Booklet content is informed by behavior change theory and written at a 6th gra ... EMPOWER is a direct-to-consumer intervention in which a booklet is mailed to older adults who are receiving high-risk medications on a chronic basis. Patients are identified from prescription records or dashboards, and booklets are personalized based on the drug(s) prescribed.
Booklet content is informed by behavior change theory and written at a 6th grade reading level, and it was subjected to extensive field testing. It includes a self-assessment about the risks of the targeted high-risk medication, presentation of evidence of harms, statements designed to create cognitive dissonance about the safety of the high-risk medication, education about dangerous drug-drug interactions, peer champion stories of older adults who have successfully switched to safer non-drug alternatives, suggestions of safer and effective alternatives, and questions to bring with them to their next appointment to discuss with their provider. See more
Booklet content is informed by behavior change theory and written at a 6th gra ... EMPOWER is a direct-to-consumer intervention in which a booklet is mailed to older adults who are receiving high-risk medications on a chronic basis. Patients are identified from prescription records or dashboards, and booklets are personalized based on the drug(s) prescribed.
Booklet content is informed by behavior change theory and written at a 6th grade reading level, and it was subjected to extensive field testing. It includes a self-assessment about the risks of the targeted high-risk medication, presentation of evidence of harms, statements designed to create cognitive dissonance about the safety of the high-risk medication, education about dangerous drug-drug interactions, peer champion stories of older adults who have successfully switched to safer non-drug alternatives, suggestions of safer and effective alternatives, and questions to bring with them to their next appointment to discuss with their provider. See more
Images
Above:
EMPOWER brochure cover page
The results
- In two RCTs including 100 community pharmacies and 800 older adults, intention to treat analyses indicated for every 3 brochures distributed, one patient eliminated high-risk medication use for 6 months.
- This intervention has also been trialed among older Veterans in VISN 22 in a quality improvement initiative and showed statistically significant reduc ... - In two RCTs including 100 community pharmacies and 800 older adults, intention to treat analyses indicated for every 3 brochures distributed, one patient eliminated high-risk medication use for 6 months.
- This intervention has also been trialed among older Veterans in VISN 22 in a quality improvement initiative and showed statistically significant reductions in benzodiazepine use.
- The EMPOWER booklet has been studied both with and without an associated prescriber-targeted intervention, and trials show that it is most effective when paired with a consult note (a form of academic detailing) sent to the prescriber (i.e., 43% cessation rate when paired with consult note, 27% cessation rate with EMPOWER brochure alone vs. 12% cessation rate in controls).
- Other preliminary evidence suggests in-person academic detailing is also effective in reducing high-risk prescribing. See more
- This intervention has also been trialed among older Veterans in VISN 22 in a quality improvement initiative and showed statistically significant reduc ... - In two RCTs including 100 community pharmacies and 800 older adults, intention to treat analyses indicated for every 3 brochures distributed, one patient eliminated high-risk medication use for 6 months.
- This intervention has also been trialed among older Veterans in VISN 22 in a quality improvement initiative and showed statistically significant reductions in benzodiazepine use.
- The EMPOWER booklet has been studied both with and without an associated prescriber-targeted intervention, and trials show that it is most effective when paired with a consult note (a form of academic detailing) sent to the prescriber (i.e., 43% cessation rate when paired with consult note, 27% cessation rate with EMPOWER brochure alone vs. 12% cessation rate in controls).
- Other preliminary evidence suggests in-person academic detailing is also effective in reducing high-risk prescribing. See more
Links
- A consumer-targeted, pharmacist-led, educational intervention to reduce inappropriate medication use in community older adults (D-PRESCRIBE trial): study protocol for a cluster randomized controlled trial Trials
- Deprescribing benzodiazepines among hospitalised older adults: quality improvement initiative BMJ Open Qual
- Direct-to-consumer strategies to promote deprescribing in primary care: a pilot study BMC Prim Care
- Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults: The D-PRESCRIBE Randomized Clinical Trial JAMA
- EMPOWERing Hospitalized Older Adults to Deprescribe Sedative Hypnotics: A Pilot Study J Am Geriatr Soc
- Use of the EMPOWER brochure to deprescribe sedative-hypnotic drugs in older adults with mild cognitive impairment BMC Geriatr
- Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial JAMA Intern Med
Metrics
- Number of VA prescribers who are contacted to consider use of EMPOWER for their eligible patients
- Number of VA prescribers who agree or disagree to mail EMPOWER brochure
- Number of Veterans mailed the EMPOWER brochure
- Cessation of prescription fills for target medications after sending the brochure
- Dose reduction by at least 25% after sending the brochure
- Rates of all-cause hospitalization and ED visits after sending the brochure
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
Planning (1-2 months)
-Identify site champions/point of contacts-Identify barriers to implementation and strategize solutions-Identify site-specific printing and mailing resources-Plan process for implementation -
Pre-Implementation (3-6 months)
-Identify pilot department(s)/team(s)-Locate EMPOWER template in CPRS-Train personnel to use VIONE dashboard and CPRS template-Engage with local leadership and stakeholders to gain buy-in-Organize reoccurring check-ins with key personnel -
Active Implementation (6 months)
-Begin intervention for patients identified as high risk in pilot department(s)/team(s)-Utilize reoccurring check-in time to identify barriers and strategize solutions-Evaluate process measures -
Consolidation (6 months)
-Expand intervention to other department(s)/team(s)-Begin to decrease occurrence of check-in meetings-Plan process for sustainment
Departments
- Mental health care
- Pharmacy
- Geriatrics
- Primary care
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- EMPOWER booklet Antipsychotic
- EMPOWER booklet Gabapentinoid
- EMPOWER Implementation Guide Packet
- EMPOWER booklet Antihistamines
- EMPOWER booklet NSAIDs
- EMPOWER booklet Opioids
- EMPOWER booklet PPIs
- EMPOWER booklet Sedative Hypnotics
- EMPOWER booklet Sulfonylurea
Links
Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
Files
- Educational resource that includes evidence for EMPOWER, deprescribing antipsychotics and gabapentinoids, and evidence-based alternatives EMPOWER Academic Detailing Educational Packet
- Academic Detailing Sign-Up Template Email
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Poor relationship between implementing departments and academic detailing pharmacist and/or pharmacy team | Encourage representatives from all implementing departments to attend reoccurring check-in meetings to build relationships |
| Concern that medication classes are medically necessary for some patients | Use VIONE’s Potentially Inappropriate Medications (PIMS) Dashboard to identify eligible patients and then determine appropriateness of sending brochure on case-by-case basis with prescriber |
| Lack of staff to implement project | Start small: identify a champion within each department to prove ease, success, etc. to others |
| Lack of time for staff to implement project | Utilize pharmacy’s population management health time |
| Lack of buy-in from prescribers | Work with Academic Detailing Pharmacist to take on EMPOWER as campaign; provide education and resources to staff on the targeted drug classes and potential alternatives |
| Staff resistant to culture change | Use the implementation guide to streamline the process as much as possible and/or adapt the intervention to local needs |
| Competing initiatives | Collaborate with other initiatives (i.e., Whole Health, VIONE, mail in medication) |
About
Original team
Robert E. Burke, MD, MS, SFHM
SAGE QUERI EMPOWER Primary Investigator
Lindsay Pelcher, MPH
SAGE QUERI EMPOWER Project Manager
Comment
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