Developing Innovative Analytical Methods for research ON Deprescribing (DIAMOND)

Medications provide important therapeutic options to prevent and manage disease and prolong life. As people age, the number of medicines prescribed tends to rise, leading to increased risk of medication-related harm. Even effective medications are often continued beyond the point of providing benefit. The WHO recognise this significant risk, designating the current Global Patient Safety Challenge Medication Without Harm. Deprescribing, the process of stopping or reducing such unnecessary medications is one critical solution to this contemporary challenge. We propose a 21st century solution, using big data to develop novel methods to identify, quantify, and address medication burden and harm as a critical public health issue. DIAMOND aims to develop and advance novel methods to research deprescribing using big data, and to apply these to generate knowledge on benefits and harms of stopping medications. The research will significantly progress methods to evaluate effects of deprescribing medications through examining optimal definitions for deprescribing and confounding control, and then emulating target trials with health record data. It will develop a novel tool to predict harm from selective serotonin reuptake inhibitors, to inform risk stratification for deprescribing. Last, it will explore prescribing cascades and how deprescribing may produce downstream benefits in reducing medication burden.