VA Initiative Addresses Unsafe Concurrent Steroid and NSAID Use in Older Veterans

Older veterans with rheumatic diseases who use glucocorticoids and non-steroidal anti-inflammatory drugs together face a greater chance of harmful side effects. To reduce that risk, a team at the US Department of Veterans Affairs has developed and tested a pilot educational program designed to make the combination safer. The program, called ScaLable Medication Deprescribing, or SLIM-D, pairs patient education with interdisciplinary collaboration and is currently operating in the rheumatology clinic at the authors’ local VA Medical Center.

The SLIM-D program was built from existing research rather than new clinical trial findings. Its developers describe it as an optimization effort focused on safer medication use, not a completed intervention with proven clinical results.

The program’s educational materials were formally reviewed for readability and clarity. Researchers applied the Flesch-Kincaid Reading Ease and Flesch-Kincaid Grade Level measures to assess difficulty, and used the Patient Education Materials Assessment Tool, or PEMAT-P, to judge how understandable and actionable the content was for patients.

Those assessments showed strong results. The invitation brochure was written at an eighth-grade reading level and scored 60.2 on Flesch-Kincaid Reading Ease, with a mean understandability score of 81.8 percent and a mean actionability score of 82.4 percent. The educational booklet was written at a ninth-grade reading level and scored 50.9 on Reading Ease, with a mean understandability score of 96.6 percent and a mean actionability score of 98.5 percent. The authors reported the results as means with standard deviations to reflect variation among raters.

A major challenge was identifying eligible patients. The team created an electronic health record query to locate veterans who could qualify for the program, along with a matching EHR note to pass eligibility information to treating clinicians. This setup allows the program to identify patients systematically rather than depending on ad hoc recognition during clinic visits.

The pilot produced early enrollment numbers. The electronic health record query identified 116 veterans eligible for the SLIM-D program. Of those, 39, or 34 percent, were invited to participate, and 7, or 18 percent of those invited, agreed to join. The authors present these figures as pilot implementation data rather than evidence of clinical benefit.

The program is now in place in the rheumatology clinic at the authors’ local VA Medical Center, and the team says it has successfully launched an effort to optimize the combined use of glucocorticoids and NSAIDs in older veterans with rheumatic and musculoskeletal diseases. Formal evaluation is still underway, so any conclusions about reduced adverse events or changes in prescribing patterns will have to wait for future results.

For now, the reported findings are limited to program development, readability and comprehension testing, and early pilot enrollment at a single site. The authors emphasize that assessment of the program’s impact is still ongoing.

Subject of Research: An educational program for safer concurrent glucocorticoid and NSAID use in older veterans with rheumatic diseases

Article Title: 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

Article References: Noboa, M. E. R., Howell, H., Gaffo, A., & Danila, M. I. (2026). 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. BMC Rheumatology. https://doi.org/10.1186/s41927-026-00689-x

Image Credits: AI Generated

Keywords: veterans, glucocorticoids, NSAIDs, rheumatic diseases, polypharmacy, patient education, deprescribing, VA rheumatology, medication safety, electronic health records, pilot program, Development