Background/Purpose: Symptomatic treatment in rheumatic and musculoskeletal diseases (RMDs) – including glucocorticoids (GCs) and non-steroidal anti-inflammatory drugs (NSAIDs) – can result in improved quality of life but also increase the rates of polypharmacy. GCs and NSAIDs combination is associated with a higher risk of serious adverse events such as acute kidney injury, cardiovascular disease, dyspepsia, and gastrointestinal (GI) bleeding. This is an important safety concern for Veterans with RMDs. The aim of this project is to create and evaluate a patient-directed informational program, entitled ScaLable Medication Deprescribing (SLIM-D). This program combines written education and case management to optimize safe medication use in older Veterans with RMDs and use GCs and NSAIDs in combination.

Methods: The SLIM-D program was developed in partnership with rheumatology clinic staff in preparation for its implementation at the Birmingham VA Medical Center. Existing educational materials from the VA-funded “Eliminating Medications through Patient OWnership of End Results” (EMPOWER) program were reviewed and used as template for the SLIM-D Veteran-facing informational booklet (Figure 1). We also created additional materials including program invitations for Veterans (Figure 2), scripts for Veteran calls, and provider electronic messages. Veteran-facing materials were assessed for readability level using Flesch-Kincaid Reading Ease (FKRE >60 representing being easily understood by 13 to 15 year olds) and Flesch Kincaid Grade Level (FKGL), with FKGL = 8-9 being an acceptable readability goal. Veterans seen at Birmingham VA Rheumatology clinic were invited to review the materials and complete the validated Patient Education Materials Assessment Tool (PEMAT-P) to determine the understandability and actionability scores of the written materials (highest score =100%, goal ≥ 80%).

Results: The FKGL readability of the invitation brochure was 8th grade with FKRE of 60.2 and the FKGL readability for the informational booklet was 9th grade with FKRE of 50.9. The invitation brochure and informational booklet were presented to 22 Veterans, 77% were men and 50% were ≥ 60 years of age. The invitation brochure had a mean (SD) understandability score 81.8% (19.8) and 82.4% (22.2) actionability score. The informational booklet had a mean (SD) 96.6% (5.8) understandability score and 98.5% (5.0) actionability score (Table 1).

Conclusion: The materials created for the SLIM-D program had a high understandability and actionability score. The SLIM-D program will offer a structured approach to reducing the combined use of GCs and NSAIDs in older Veterans with RMD. Providing information materials to the Veteran will encourage a discussion of safe medication use with their clinician and might promote a decrease in polypharmacy among this population. We will implement the SLIM-D program at Birmingham VA Medical Center to determine rates of Veteran participation, and evaluate its feasibility, acceptability, and appropriateness from the Veterans perspective.

Figure 1: SLIM-D Program Informational Booklet Cover Page

Figure 2: SLIM-D Program Informational Brochure

Table 1: Assessment of Understandability, Actionability Scores and Readability for SLIM-D Educational Materials In Veterans with Rheumatic and Musculoskeletal Diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-and-implementation-of-a-remote-educational-program-to-optimize-safe-medication-use-in-older-veterans-with-rheumatic-diseases/