Development and pilot implementation of an educational program for concurrent use of non-steroidal anti-inflammatory drugs and glucocorticoids in older veterans with rheumatic diseases

Abstract Background Polypharmacy is common among aging Veterans with rheumatic and musculoskeletal diseases (RMDs). Veterans who concurrently use glucocorticoids (GCs) and non-steroidal anti-inflammatory drugs (NSAIDs) have higher risk of adverse events. We created the ScaLable Medication Deprescribing (SLIM-D) program that integrates education and interdisciplinary collaboration to optimize safe use of NSAIDs and GCs at the VA. Methods The SLIM-D program was designed using insights from existing literature. Flesch-Kincaid Reading Ease (FKRE) and Flesch Kincaid Grade Level (FKGL) assessed the reading level of SLIM-D materials, while Patient Education Materials Assessment Tool (PEMAT-P) assessed their understandability and actionability. To identify Veterans eligible for the program we developed an electronic health record (EHR) query. We also created an EHR note to communicate to the treating clinicians regarding Veteran eligibility for the program. The SLIM-D program is currently implemented in the rheumatology clinic at our local VA Medical Center. Results The SLIM-D program included: an invitation brochure (reading level 8th grade, FKRE = 60.2, mean (SD) understandability score 81.8% (19.8), actionability score 82.4% (22.2)) and an educational booklet (reading level 9th grade; FKRE = 50.9; mean (SD) understandability score 96.6% (5.8), actionability score was 98.5% (5.0)). As of February 2026, an electronic health record query identified 116 Veterans eligible for the SLIM-D program, 39 (34%) were invited to participate, with 7 (18%) agreeing to participate. Conclusion We successfully created and implemented the SLIM-D program to optimize the concomitant use of GCs and NSAIDs in older Veterans with RMDs at our local VA rheumatology clinic. Program evaluation is ongoing.