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Published on: November 7, 2014
Potentially Inappropriate Medications in Older Adults: Deprescribing with a Clinical Pharmacist
Catherine A Ammerman1, Brent A Simpkins1, Nora Warman1
1Veterans Affairs Medical Center, Lexington, Kentucky.
Objectives:
To compare the effects of a Geriatric Patient-Aligned Care Team (GeriPACT) on deprescribing of potentially inappropriate medications (PIMs) in individuals aged 80 and older with usual care (UC) in the Veterans Affairs setting.
Design:
Retrospective cohort study.
Setting:
Veterans Affairs Medical Center in Lexington, Kentucky.
Participants:
Individuals aged 80 and older who filled a PIM at least 90 days before a GeriPACT or primary care appointment between January 1, 2015, and September 6, 2017 (N = 568).
Measurements:
The primary outcome was to determine whether an interdisciplinary team (IDT) including a clinical pharmacy specialist (CPS) resulted in greater deprescribing of PIMs for older adults than UC.
Results:
One hundred twenty-one (26.8%) PIMs were deprescribed in GeriPACT, compared with 73 (16.1%) in UC (p = <.001). Of PIMs not deprescribed, 9.7% (n = 32) were dose reduced in GeriPACT, versus 2.8% (n = 11) in UC (p < .001). Documentation of risk versus benefit discussion between a provider and participant or pharmacist and participant occurred with 65.2% (n = 215) of PIMs not deprescribed in GeriPACT and 0.003% (n = 1) in UC (p < .001).
Conclusion:
An IDT that included a CPS led to significantly more deprescribing of PIMs in older veterans. Including a CPS on an IDT for the management of older adults can decrease PIM use in our rapidly growing aging population. J Am Geriatr Soc 67:115-118, 2019.
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