A United Hospital Fund partnership with nursing homes focused on safe “deprescribing”—decreasing the use of potentially inappropriate medications—has successfully reduced the number of residents taking 10 or more medications for the second year.
The Polypharmacy Learning Collaborative, which partnered with seven New York-area nursing homes in 2023, saw a 12 percent decrease in the number of residents taking 10 or more medications across the facilities. The average number of medications prescribed to each resident also dropped from 10 to 9.2.
Polypharmacy, or the prescribing of an inappropriately high number of medications, has been shown to increase adverse outcomes like drug-drug interactions, falls, cognitive impairment, and hospitalization.
The promising results from the second year of the project were discussed at a final learning session held January 30 at UHF’s office.
“We're so pleased with how this year has gone,” UHF Senior Program Manager Alice Ehrlich told participants. “Collectively, you made such a substantial impact on the prescribing practices in your facilities, which is exactly what we set out to do with this project.”
During the final learning session, participants and learning collaborative faculty—T.S. Dharmarajan, MD, and Jennifer Pruskowski, RPh, PhD—reflected on the successes and challenges of the six-month deprescribing interventions. They also discussed strategies for sustaining the impact of the initiative long-term with a presentation from Kathy Rauch, RN, MSHQS, BNS, CPHQ, the vice president of quality advocacy, research, and innovation at the Healthcare Association of New York State.
The learning collaborative’s second year included a new focus on integrating each intervention with an innovative framework known as Age-Friendly Health Systems. This model aims to improve patient-centered care for adults through principles known as the four Ms: What Matters, Medication, Mentation, and Mobility.
Two newly recruited nursing facilities joined the collaborative during the second year, and the list of high-risk medications targeted for deprescribing and dose reduction was also expanded.
In their six-month interventions in 2023, the seven participating nursing homes made more than 400 dose reductions or discontinuations for their selected medications, which included opioids, mood stabilizers, Alzheimer’s and dementia treatment medications, and proton pump inhibitors—the world’s most prescribed drug.
Certain facilities saw particularly staggering success. At one facility, the proportion of residents taking 10 or more medications was cut in half, and the average number of medications prescribed to each resident fell from 10 to 6. Plus, at six of the seven nursing homes, the proportion of residents taking at least one of the targeted medications dropped by half.
As in the first year, nursing home participants described how these changes had a meaningful impact on many residents’ quality of life, including increased energy and participation in activities and more socialization. Participants also discussed how the changes could help with staff retention or burnout by, for some, reducing workload and enabling staff to spend more time in direct patient care.
The findings of The Polypharmacy Learning Collaborative’s second year will soon be released in a report and disseminated widely. The results build on the successful inaugural year of the project, which saw a 16 percent decrease in the number of residents taking 10 or more medications. More on those results, as well as lessons and recommendations from the first year can be found in the report Reducing the Risk: Year 1 Report of the Polypharmacy in Nursing Homes Learning Collaborative.