Operation Polypharmacy: a pharmacist-led ambulatory care clinic design and evaluation for older patients

The unintended consequences of polypharmacy pose significant risks to older adults. The complexities of managing numerous medications from multiple prescribers demand a comprehensive approach to mitigate harms. Pharmacist-led clinics have been shown to improve outcomes in patients with diabetes and hypertension. Pharmacist-led clinics focused on broader issues of polypharmacy have the potential to lead to better outcomes for older patients. We describe the design and the pre-post evaluation of a polypharmacy clinic. We conducted a retrospective standardized chart review of polypharmacy visits during October and November 2022. Systematic data collection was completed by March 2023. Our review included 84 polypharmacy visits; the average patient age was 80. Patients were on 17.3 (range: 7-33) medications at-visit and 15.9 (range: 4-30) medications post-visit, with an average of 1.4 medications deprescribed per visit. In patients with many medications (range: 17-33 medications) at the polypharmacy consult visit, 2.6 medications were deprescribed post-visit. In patients with a moderate number of medications (range: 7-16 medications) at-visit, 0.9 medications were deprescribed post-visit. Medication list accuracy increased to 72% at follow-up visits compared to initial visits (66%). 44% of patients were on 1 or more Potentially Inappropriate Medications (PIMs) and 24% were on 1 or more Drugs with Strong Anticholinergic Properties (DSAPs) at initial visits. At follow-up visit, the proportion of patients with PIMs decreased by 28%, and the proportion of patients with DSAPs decreased by 54%. Our evaluation demonstrates the value of a polypharmacy clinic in improving medication list accuracy and deprescribing PIMs and DSAPs.