A Pharmacist-led Pilot Program to Facilitate Deprescribing in a Primary Care Clinic

Abstract

Objective:

To develop and pilot test a model in which a community-based clinical pharmacist was incorporated as part of a Medicare Annual Wellness Visit (AWV) to make deprescribing recommendations targeted at potentially inappropriate medications (PIMs) in the elderly.

Setting:

One family medicine Patient-centered medical home (PCMH) clinic in Buffalo, NY.

Practice description:

Implementation and evaluation of a pilot program incorporating a pharmacist provided medication review targeting PIMs in the elderly as part of a Medicare AWV.

Practice innovation:

A community pharmacy-based clinical pharmacist provided face-to-face medication reviews for patient’s over 65 years old as part of their AWV with a focus on deprescribing PIMs. No clinical pharmacy service existed at the practice when this program was implemented.

Evaluation:

Identified PIMs, pharmacist recommendations, recommendation acceptance rate, time spent on intervention, healthcare utilization at 6 months post visit, and barriers to implementation.

Results:

Of the 21 patients enrolled, the pharmacist provided a total of 20 deprescribing recommendations for 13 unique patients. The overall acceptance rate for pharmacist recommendations was 20%. The pharmacist spent a mean (standard deviation) of 34 (6) minutes per patient encounter. One patient in the intervention group was hospitalized and 1 was seen in the emergency department (ED) during the 6-month follow up period compared to 1 patient in the control group who had an ED visit. We identified multiple logistical and organizational barriers to implementation of the intervention.

Conclusion:

In this prospective pilot study, a workflow to include a pharmacist medication review to facilitate deprescribing in the primary care setting was tested. We encountered a number of barriers integrating the pharmacist into AWV workflow to deliver the intervention. Future pragmatic clinical trials are warranted to improve provider awareness and comfort with deprescribing PIMs medications in the elderly.