United Hospital Fund’s polypharmacy learning collaborative, now in its second year, explores how to reduce the burden of overprescribing in nursing homes. The seven participating skilled nursing facilities recently came together to identify ways they can continue to build on the successes of the first year, during which the facilities observed a 16 percent decrease in the proportion of residents prescribed 10 or more medications.
Polypharmacy is the prescribing of an inappropriately high number of medications that may increase adverse outcomes like drug-drug interactions, falls, cognitive impairment, and hospitalization. The participating facilities are designing and implementing strategies to better monitor and assess medication regimens and prescribing practices. They are also looking at the use of deprescribing—the practice of withdrawing patients from certain medications, supervised by a health care professional, with the goal of improving outcomes.
The project is funded by the Mother Cabrini Health Foundation, with additional support from the TD Charitable Foundation. Its first learning session of 2023 was held in March.
The most recent learning session was held on June 6 at UHF’s office. A clinical portion featured a presentation by Dr. Steven Levenson on “Tapering Psychopharmacological Medications.” Dr. Levenson, widely recognized for pioneering work in medical direction and efforts to improve geriatrics and long-term care, urged keeping the patient front and center: “It’s not about the drug—it’s about the patient,” he said. “Try to understand the patient before dealing with the drugs.”
The second part of the clinical portion was a review of challenging deprescribing cases by learning collaborative faculty member T.S. Dharmarajan, MD. Dr. Dharmarajan is vice chairman, department of medicine, clinical director, division of geriatrics, and the program director, geriatric medicine fellowship program at Montefiore Medical Center; he’s also a professor of medicine at the Albert Einstein College of Medicine.
Nursing home representatives also provided updates on their efforts at the June 6 meeting and discussed ongoing challenges. They noted successes in deprescribing as well as continued progress in getting buy-in from residents, family members, and staff.
“The learning collaborative has really given us the opportunity to do this in an organized fashion, which we didn’t have before,” said the team lead from one nursing home. Another noted: “We really stepped on the gas and made some great efforts.”
Learning collaborative participants said they benefited from the project’s use of a framework known as Age-Friendly Health Systems. The model provides a set of four evidence-based principles aimed at improving patient-centered care for older adults, known as the four Ms: What Matters, Medication, Mentation, and Mobility.
“We sit down with residents and ask: ‘How are you doing? What matters to you most in your life?” one nursing home representative said.
UHF will soon publish its 2022 findings, together with tools and recommendations for other organizations wishing to develop their own deprescribing initiatives.