Discussion
The STOP-FALLS study builds on evidence demonstrating the effectiveness of direct-to-consumer education on reducing use of potentially inappropriate medications by older adults [Several features of the STOP-FALLS study are novel. First, the STOP-FALLS intervention is a modification of an evidence-based deprescribing intervention [Study strengths include the pragmatic design, clinic-level randomization that minimizes the risk of contamination, blinding of investigators and data analysts for outcomes assessments, objective assessment of dose reduction/discontinuation using pharmacy fill records and data from signetur fields [Study limitations include the setting, which is an integrated delivery system. Results from STOP-FALLS may not be generalizable to other clinical settings. In addition, because pharmacists employed by the delivery system have limited time and availability to engage in research studies, and also because during the time of the trial they have been implementing a system-wide opioid dose reduction initiative, they were unable to take on a dedicated role as part of the intervention, and as a result, we will be unable to assess the effectiveness of systematic involvement of a pharmacist as part of our intervention. Lastly, patient-reported outcomes that may be impacted by the intervention will not be assessed due to the pragmatic nature of trial data collection.In summary, the STOP-FALLS trial will generate evidence regarding the effectiveness of a health-system-embedded deprescribing intervention on medically treated falls, a patient-centered outcome of high relevance to older adults. Secondary (medication-related) outcomes will illuminate whether a nudge intervention is effective in reducing medications associated with fall risk. Low-intensity interventions that are relatively simple and scalable for health systems are critical for achieving age-friendly care.