So Seth, tell us a little bit about the landscaping of deprescribing and how this intervention advances our understanding of what works and help us sort of situate the results in the literature.

Sure.

Yeah, deprescribing has become increasingly important because as in this situation, the indications for using certain drugs has evolved over time.

And also people get started on drugs many years ago that may be increasingly dangerous now.

Initial efforts at deprescribing really focused on smaller drugs.

practice-based interventions.

And one of the things that's really unique about what Jacob has done here is this effort that touched tens of thousands of patients in a healthcare system that can be relatively easily extended across the rest of the VA.

And that's not only research, but clinically, we need to be conferring with each other to make the best clinical decisions for our patients.

So Seth, tell us a little bit about the landscaping of deprescribing and how this intervention advances our understanding of what works, and help us sort of situate the results in the literature.

Sure.

You know, deprescribing has become increasingly important because, as in this situation, the indications for using certain drugs has evolved over time, and also people get started on drugs, you know, many years ago that may be increasingly dangerous now.

Initial efforts at deprescribing really focused on smaller practice-based interventions, and one of the things that's really unique about what Jacob has done here is this effort that touched tens of thousands of patients in a healthcare system that could be relatively easily extended across the rest of the VA.

Another thing that has really been, I think, very potent and interesting in this intervention is the multi-component dimension of it, bringing in academic detailing, improving the knowledge base and practice of individual clinicians, physicians, and advanced practice providers, also trying to improve the knowledge base of patients since, in this case, many of the drugs, the aspirin is often taken over the counter.

And then also this clinical pharmacy component is really, I think, a very potent part of this intervention where the pharmacists themselves are actively engaged on a system level in managing prescription.

So they're very well positioned to do deprescribing to eliminate the use of drugs that we now know are toxic.

We're really working together, and that's not only in research, but clinically, we need to be conferring with each other to make the best clinical decisions for our patients.