Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study. Green AR, et al, J Am Geriatr Soc 2024.
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Résumé et points clés
Background: People living with dementia (PLWD) have complex medication regimens, exposing them to increased risk of harm. Pragmatic deprescribing strategies that align with patient-care partner goals are needed.
Methods: A pilot study of a pharmacist-led intervention to optimize medications with patient-care partner priorities, ran May 2021-2022 at two health systems. PLWD with ≥7 medications in primary care and a care partner were enrolled. After an introductory mailing, dyads were randomized to a pharmacist telehealth intervention immediately (intervention) or delayed by 3 months (control). Feasibility outcomes were enrollment, intervention completion, pharmacist time, and primary care provider (PCP) acceptance of recommendations. To refine pragmatic data collection protocols, we assessed the Medication Regimen Complexity Index (MRCI; primary efficacy outcome) and the Family Caregiver Medication Administration Hassles Scale (FCMAHS).
Results: 69 dyads enrolled; 27 of 34 (79%) randomized to intervention and 28 of 35 (80%) randomized to control completed the intervention. Most visits (93%) took more than 20 min and required multiple follow-up interactions (62%). PCPs responded to 82% of the pharmacists' first messages and agreed with 98% of recommendations. At 3 months, 22 (81%) patients in the intervention and 14 (50%) in the control had ≥1 medication discontinued; 21 (78%) and 12 (43%), respectively, had ≥1 new medication added. The mean number of medications decreased by 0.6 (3.4) in the intervention and 0.2 (1.7) in the control, reflecting a non-clinically meaningful 1.0 (±12.4) point reduction in the MRCI among intervention patients and a 1.2 (±12.9) point increase among control. FCMAHS scores decreased by 3.3 (±18.8) points in the intervention and 2.5 (±14.4) points in the control.
Conclusion: Though complex, pharmacist-led telehealth deprescribing is feasible and may reduce medication burden in PLWD. To align with patient-care partner goals, pharmacists recommended deprescribing and prescribing. If scalable, such interventions may optimize goal-concordant care for PLWD.
Références de l'article
- Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study.
- Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study.
- Green AR, Quiles R, Daddato AE, Merrey J, Weffald L, Gleason K, Xue Q, Swarthout M, Feeser S, Boyd CM, Wolff JL, Blinka MD, Libby AM, Boxer RS
- Journal of the American Geriatrics Society
- 2024
- J Am Geriatr Soc. 2024 Jul;72(7):1973-1984. doi: 10.1111/jgs.18867. Epub 2024 Mar 15.
- Humans, Pilot Projects, *Polypharmacy, *Deprescriptions, Female, Male, *Telemedicine, *Dementia/drug therapy, *Pharmacists, *Primary Health Care, Aged, Aged, 80 and over, Caregivers, Feasibility Studies
- Soins, Syndromes_Geriatriques, Neurocognitif, Aidants_Soignants, Ambulatoire
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- Traduction automatique en Français sur Google Translate
- DOI: 10.1111/jgs.18867
- PMID: 38488757
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