Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study

Ariel R Green; Rosalphie Quiles; Andrea E Daddato; Jessica Merrey; Linda Weffald; Kathy Gleason; Qian-Li Xue; Meghan Swarthout; Scott Feeser; Cynthia M Boyd; Jennifer L Wolff; Marcela D Blinka; Anne M Libby; Rebecca S Boxer

doi:10.1111/jgs.18867

Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study

J Am Geriatr Soc. 2024 Mar 15. doi: 10.1111/jgs.18867. Online ahead of print.

Authors

Ariel R Green¹, Rosalphie Quiles¹, Andrea E Daddato², Jessica Merrey³, Linda Weffald^{2

4}, Kathy Gleason², Qian-Li Xue^{1

5}, Meghan Swarthout³, Scott Feeser⁶, Cynthia M Boyd¹, Jennifer L Wolff^{1

7}, Marcela D Blinka^{1

5}, Anne M Libby⁸, Rebecca S Boxer⁹

Affiliations

¹ Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Kaiser Permanente Colorado Institute for Health Research, Aurora, Colorado, USA.
³ Johns Hopkins Medicine, Baltimore, Maryland, USA.
⁴ Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, Colorado, USA.
⁵ Johns Hopkins Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁶ Johns Hopkins Community Physicians, Baltimore, Maryland, USA.
⁷ Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁸ Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁹ Davis Department of Medicine, University of California, Sacramento, California, USA.

PMID: 38488757
DOI: 10.1111/jgs.18867

Abstract

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.

Keywords: dementia; deprescribing; primary care.

Abstract

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