Pharmacist-driven deprescribing initiative in primary care

Area of Science:

• Geriatrics
• Pharmacology
• Health Services Research

Background:

• Polypharmacy is linked to adverse health outcomes including frailty, falls, and mortality.
• The Veterans Health Administration (VHA) utilizes the VIONE dashboard to identify patients with polypharmacy.
• Deprescribing initiatives aim to reduce unnecessary medication use and improve patient safety.

Purpose of the Study:

• To describe the implementation of a pharmacist-led, system-wide deprescribing initiative in primary care.
• To evaluate the effectiveness of this initiative in reducing polypharmacy and its associated costs.

Main Methods:

• Interdisciplinary education was provided via academic detailing.
• Patients were identified using the VIONE dashboard, prioritizing those at highest risk.
• Clinical pharmacist practitioners (CPPs) reconciled medications, discussed deprescribing options with patients, and relayed recommendations to primary care providers (PCPs).

Main Results:

• A total of 352 medications were deprescribed among 63 patients.
• This resulted in a potential annualized cost avoidance of $184,221.
• The acceptance rate for medication discontinuation recommendations was 96.7%, with 25.4% of patients referred to pharmacist-led clinics.

Conclusions:

• Integrating deprescribing into standard CPP workflows in primary care effectively reduces polypharmacy.
• This initiative facilitated the expansion of pharmacy-led services within the VA Butler Healthcare System.
• Pharmacist-led deprescribing improves patient outcomes and generates significant cost savings.