Clinical Pharmacy Forum
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Service or Program: Polypharmacy and use of potentially inappropriate medications (PIMs) in older adults is associated with poor outcomes, increased healthcare utilization, and higher costs. Hospitalization represents an opportunity to reduce polypharmacy and PIMs, improving medication safety. Through a quality improvement framework, a polypharmacy intervention was developed for hospitalized older adults (age=65). A layered learning model of PharmD students, PGY-1 pharmacy residents, and attending pharmacotherapy specialists conducted a comprehensive medication review at admission to identify medication therapy problems (MTPs), identify PIMs using validated criteria, and provide pharmacotherapy and deprescribing recommendations. The intervention was piloted on one internal medicine/geriatric service at an academic medical center over six months to evaluate effectiveness and determine scalability.
Justification/Documentation: Comprehensive polypharmacy deprescribing assessments were provided to 162 patients. Polypharmacy occurred in 98.7% of older adults, whereas 55.7% received a PIM. This demonstrates a significant need for a targeted intervention to address polypharmacy and PIMs during hospitalization. A median of 2 MTPs were identified per patient, the most common being adverse drug reaction (30.7%), medication without indication (22%), and indication without medication (22%). Opioids were the most common PIM (45.6%), followed by benzodiazepines (14%) and sulfonylureas (12.3%). There was no change in the median number of home medications from admission to discharge (11 vs. 12). 43% of recommendations were implemented.
Adaptability: The intervention can be readily applied by pharmacotherapy specialists within a general medicine service, with or without a layered learning model. Training on PIMs and polypharmacy is encouraged. Integration with medication reconciliation, discharge counseling, or transitions of care teams would improve efficiency and may increase implementation. Identification and application to the target populations is facilitated with simple reporting tools.
Significance: This polypharmacy intervention positions pharmacotherapy specialists and learners to optimize care via a deprescribing framework. Using hospitalization as a key touchpoint is novel but has challenges due to transitions of care.
Presenting Author
Calvin Meaney PharmD, BCPSUniversity at Buffalo School of Pharmacy and Pharmaceutical Sciences
Authors
Michael Ott PharmD, BCPS
Erie County Medical Center
Kevin Pham PharmD Student
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Gina M. Prescott PharmD, BCPS
University at Buffalo
Fred Doloresco PharmD, MS
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Zachary Wikerd MD
Erie County Medical Center