Assessment of a Medication Deprescribing Tool on Polypharmacy and Cost Avoidance

Constantino-Corpuz, Janie K.; Alonso, Monika Tara D.

doi:10.12788/fp.0146

Cited by 5 publications

(8 citation statements)

References 8 publications

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“…Many iterations of the template were trialed to optimize functionality. The note was reviewed from multiple sites for collaborative agreement and assessed by other deprescribing initiatives such as VIONE (vital, important, optional, not indicated/treatment complete, and every medication has an indication) and EQUIPPED 18–20 . The overall goal was creating a note that could be completed by the pharmacist in real time, easily identifying PIMs, and succinctly documenting recommendations to the primary care team.…”

Section: Methodsmentioning

confidence: 99%

Implementation of a compulsory clinical pharmacist‐led medication deprescribing intervention in high‐risk seniors in the emergency department

Jovevski

Smith

Roberts

et al. 2023

Academic Emergency Medicine

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Objectives The objective of this study was to assess the impact of an emergency department (ED) deprescribing intervention for geriatric adults. We hypothesized that pharmacist‐led medication reconciliation for at‐risk aging patients would increase the 60‐day case rate of primary care provider (PCP) deprescribing of potentially inappropriate medications (PIMs). Methods This was a retrospective, before‐and‐after intervention pilot study conducted at an urban Veterans Affairs ED. In November 2020, a protocol utilizing pharmacists to perform medication reconciliations for patients 75 years or older who screened positive using an Identification of Seniors at Risk tool at triage was implemented. Reconciliations focused on identifying PIMs and providing deprescribing recommendations to patients' PCPs. A preintervention group was collected between October 2019 and October 2020, and a postintervention group was collected between February 2021 to February 2022. The primary outcome compared case rates of PIM deprescribing in the preintervention group to the postintervention group. Secondary outcomes include per‐medication PIM deprescribing rate, 30‐day PCP follow‐up visits, 7‐ and 30‐day ED visits, 7‐ and 30‐day hospitalizations, and 60‐day mortality. Results A total of 149 patients were analyzed in each group. Both groups were similar in age and sex, with an average age of 82 years and 98% male. The case rate of PIM deprescribing at 60 days was 11.1% preintervention compared to 57.1% postintervention (p < 0.001). Preintervention, 91% of PIMs remained unchanged at 60 days compared to 49% (p < 0.05) postintervention. Regardless of PIM identification, the 30‐day primary care follow‐up rate increased postintervention: 31.5% and 55.7% (p < 0.0001), respectively. There was no improvement in 7‐ or 30‐day subsequent ED visits, hospitalization, or mortality. Conclusions Pharmacist‐led medication reconciliation in high‐risk geriatric patients was associated with an increase both in the rate of PIM deprescribing and in post‐ED primary care engagement.

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Section: Methodsmentioning

confidence: 99%

Implementation of a compulsory clinical pharmacist‐led medication deprescribing intervention in high‐risk seniors in the emergency department

Jovevski

Smith

Roberts

et al. 2023

Academic Emergency Medicine

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“…Scores of 4 or 5 are considered high risk for medication‐related adverse events. In addition to VIONE scores, the national dashboard reports the number of potentially inappropriate medications (PIM) and applicable medications on the Beers list 17 …”

Section: Methodsmentioning

confidence: 99%

Implementing preemptive, multigene, pharmacogenomic testing in the inpatient setting: Preliminary results from a small, rural facility

Cole

2023

J Am Coll Clin Pharm

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IntroductionPreemptive pharmacogenomic (PGx) testing is on the rise among United States health care centers, with the majority of testing performed in the primary care setting. For broader implementation, there is a call for descriptions of the implementation and workflow of successful PGx programs in a large variety of health care settings.ObjectiveThe purpose of this study was to describe the implementation and initial outcomes of preemptive PGx (11‐gene, multipanel) testing in inpatient workflow at a Veterans Affairs medical center.MethodsThe inpatient clinical pharmacist incorporated patient screening, informed consent, and PGx lab ordering into their daily workflow in March 2023. Included adult patients had to be enrolled into the facility's primary care program and able to provide informed consent. Patients were excluded if they had a history of bone marrow or liver transplant, were consulted for palliative or hospice care, or had altered mental status at the time of screening. A retrospective chart review was used to collect demographics and PGx results from March to August 2023.ResultsThere were 247 patients screened for PGx testing in the 6‐month study period. Of these, 74 already had PGx performed, 31 declined or deferred testing, and 142 consented to testing. Laboratory blood draw was not performed as ordered on 12 patients, leaving 130 samples with results. Of 130 patients, 129 (99%) had an actionable PGx variant, with most having multiple variants: one variant (6%), two variants (15%), three variants (32%), four variants (24%), five variants (18%), and six variants (3%). At the time of follow‐up, 64 (49%) patients were prescribed an affected medication: one medication (38%), two medications (8%), and three medications (3%).ConclusionIncorporating preemptive PGx testing into inpatient workflow is feasible in a rural facility with a significant proportion of patients being affected by the results.

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“…The VIONE tool has aided in successfully reducing medication use and cost in a variety of VA healthcare settings. 8 A second model is direct-to-patient materials. Initially tested in community pharmacies in Quebec, Canada, the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) cluster randomized trial demonstrated a significant reduction of benzodiazepine prescriptions with patient-facing brochures outlining the risks of benzodiazepine use and a stepwise tapering protocol.…”

Section: Why Does This Paper Matter?mentioning

confidence: 99%

“…VIONE also utilizes a robust national dashboard capturing deprescribing data in real time and automating reports that integrate individual patient data and the administrative data portals and VA Corporate Data Warehouse. The VIONE tool has aided in successfully reducing medication use and cost in a variety of VA healthcare settings 8 . A second model is direct‐to‐patient materials.…”

Section: Introductionmentioning

confidence: 99%

A virtual breakthrough series collaborative to support deprescribing interventions across Veterans Affairs healthcare settings

Phillips,

Mecca,

Baim‐Lance

et al. 2023

J American Geriatrics Society

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BackgroundVirtual collaborative models are a practical way to implement a supportive environment for multi‐team learning. In this project, we aimed to describe the processes and outcomes of a virtual deprescribing collaborative that facilitated implementation of deprescribing interventions around the country.MethodsTwo successive cohorts comprised of multidisciplinary teams from geographically diverse veterans affairs (VA) sites were selected via an application process to participate in a virtual deprescribing collaborative. Each site developed its own deprescribing protocol and took part in regular meetings, mentoring groups, monthly data reporting, and other learning activities over an approximate 9 month period, per cohort. Standard measures were number of veterans served and medications deprescribed. Descriptive and qualitative analyses were utilized.ResultsTwenty‐one total VA sites were selected to participate in the deprescribing collaborative in two cohorts (Cohort 1, n = 12 sites; Cohort 2, n = 9 sites). The majority of sites' practice areas directly served the older adult population, and the majority of site leads were pharmacists. The most utilized tool used by the collaborative sites was the VA VIONE decision support tool (n = 14) and the most common strategy was individualized medication review. Combining outcomes from both Cohorts 1 and 2, a total of n = 4770 veterans were served, with 8332 medications deprescribed. Eighty‐two percent of Cohort 1 sites surveyed reported their deprescribing program was still being utilized after 1 year follow up.ConclusionsThis virtual deprescribing collaborative aided in the successful implementation of both established and novel deprescribing practices across a variety of VA practice sites that care for older adults. The shared learning experience enhanced problem solving and allowed for interdisciplinary teamwork. Overall the collaborative was successful in improving polypharmacy for several thousand older adults.

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Assessment of a Medication Deprescribing Tool on Polypharmacy and Cost Avoidance

Cited by 5 publications

References 8 publications

Implementation of a compulsory clinical pharmacist‐led medication deprescribing intervention in high‐risk seniors in the emergency department

Implementation of a compulsory clinical pharmacist‐led medication deprescribing intervention in high‐risk seniors in the emergency department

Implementing preemptive, multigene, pharmacogenomic testing in the inpatient setting: Preliminary results from a small, rural facility

A virtual breakthrough series collaborative to support deprescribing interventions across Veterans Affairs healthcare settings

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