Number of Residents Taking 10 or More Medications Decreased by 16 %
NEW YORK, NY—September 19, 2023—A partnership between United Hospital Fund (UHF) and six New York-area nonprofit nursing homes focused on safe “deprescribing”—decreasing the use of potentially inappropriate medications—successfully reduced the number of residents taking 10 or more medications by 16 percent over a four-month period, according to a report released today. The report, Reducing the Risk: Year 1 Report of the Polypharmacy in Nursing Homes Learning Collaborative, also found that participating nursing homes reduced the average number of medications prescribed per nursing home resident from 10.7 to 8.7.
Prescribing an inappropriately high number of medications, known as polypharmacy, is a particular concern in nursing homes. An estimated 50 percent of nursing home residents receive nine or more medications, and their rate of adverse drug reactions is twice as high as that of residents taking fewer than nine. While the use of multiple medications is often appropriate in managing patients with complex chronic diseases, some medications may be unnecessary, duplicative, have limited benefit, cause a range of harmful side effects, or be inconsistent with a resident’s care goals or current practice standards.
“We are very encouraged that all six participating nursing homes, which varied in size, staffing, resources, and targeted medications, were successful in their deprescribing efforts,” said Joan Guzik, director of quality and efficiency at UHF’s Quality Institute and one of the authors of the report. “This project demonstrates that engaging an interdisciplinary team and partnering with residents and their families can safely decrease polypharmacy, which in turn can improve residents’ health outcomes and quality of life.”
The Polypharmacy in Nursing Homes Learning Collaborative focused on four medication categories: proton pump inhibitors for acid reflux, the world’s most prescribed drug; antihypertensives for high blood pressure; benzodiazepines, a class of drugs for anxiety; and cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and dementia symptoms. Participating nursing homes each chose two of these medications to target.
UHF’s Quality Institute launched the collaborative in 2022 with six New York-based skilled nursing facilities to design and implement ways to better monitor and assess medication regimens and prescribing practices. The six participating facilities were ArchCare at Mary Manning Walsh, Cobble Hill Health Center, Eger Health Care and Rehabilitation Center, Gurwin Jewish Nursing and Rehabilitation Center, The Hebrew Home at Riverdale, and Jamaica Hospital Nursing Home. The new report outlines successful interventions and lessons learned in the first year of the program and highlights strategies and resources for other nursing homes to alleviate the risks and burdens of overprescribing.
The report summarizes key lessons learned during the collaborative: leadership and education are crucial to implementing a deprescribing initiative; every member of the care team has a role to play in the deprescribing effort; engaging residents and families is key; analyzing and monitoring prescribing data is essential; and a quality improvement approach facilitates organization-wide deprescribing.
The report also notes the project’s impact on nursing home residents, costs, and staff. One resident was slowly deprescribed a benzodiazepine and became less sleepy during the day, allowing him to participate in recreational activities with more enthusiasm. After successful deprescribing of a dementia medication for an underweight patient, his appetite improved and he gained weight. One nursing home reported saving $40,000 in pharmacy bills within seven weeks of launching its intervention.
“This report demonstrates that overall public awareness about the risks of polypharmacy in older adults, attention to medication reconciliation across all care settings, and family engagement are all key to successful and safe deprescribing efforts,” said Oxiris Barbot, MD, president and CEO of United Hospital Fund. “We hope nursing homes across the city, state, and country will learn from the report’s tools, resources, and approaches.”
The polypharmacy initiative is supported by the Mother Cabrini Health Foundation and TD Charitable Foundation. In addition to Ms. Guzik, the report was written by Alice Ehrlich, senior program manager, Quality Institute, and Kevin Mallon, MSW, program manager, Quality Institute.
The report can be downloaded free of charge from UHF’s website here:
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