We will use EHR data to identify eligible patients at BWH primary care clinics. Patients will be eligible if they have an upcoming primary care provider (PCP) appointment at an included BWH clinic, are ≥65 years, and are eligible for a medication target; exclusion criteria will include relevant EHR-documented allergies. After sharing patients with PCPs for potential opt-out, patients will be randomized 1:1 in REDCap® to intervention or usual care (no prompt). The intervention will include a pre-visit patient-facing prompt with information about the evidence-based medication target. If patients are eligible for multiple targets, one will be randomly selected. The primary clinical outcome will be measured on the day of the PCP visit using EHR data, depending on target: a) discontinuation or tapering order, or b) prescribing. Secondary outcomes will include a) these same measures in a 60-day follow-up period after the visit to capture any follow-up actions. We will use an intention-to-treat approach including patients regardless of whether the visit occurred. We plan to conduct the trial until 1700 patients are reached. We will also conduct exploratory mediation analyses of mechanisms through brief patient surveys with behavioral scales and PCP survey.

Inclusion Criteria:

• ≥65 years of age
• Have an upcoming clinic appointment with a BWH PCP at one of the included clinics

In addition, they must meet the following eligibility criteria for at least one medication target behavior (based on EHR data):

1. Statin use for primary prevention (65-75 years of age): Having a EHR diagnosis or problem list documentation of: diabetes, hypertension, smoking, or high cholesterol and estimated eligible cardiovascular risk
2. High-risk medication use (≥65 years of age): Have an active outpatient prescription for ≥1 medication on the American Geriatrics Society Beers Criteria® List for Avoid Medications based on EHR records

Exclusion Criteria:

• Documented allergy to one of the components (statin)
• Current or recent prescription for a statin or PCSK9-inhibitor or bempedoic acid
• Primary language recorded other than English or Spanish

The project will result in a Limited Data Set and a de-identified data set of the outcomes, intervention arms, and sociodemographic and clinical characteristics.

These data will be available upon request. To the extent the context of data collection can be revealed without compromising privacy and identity of research participants, it will be included. Algorithms and other programming code used to identify patients for the study and evaluate study outcomes will be available upon request. We will also provide the underlying logic to build the tools to other health systems upon request.

Data will be controlled access with the General Research Use Data Use Limitation, as allowed by the informed consent and the institutional certification, anticipated through the Aging Research Biobank.