Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
VA Connecticut Healthcare System, West Haven, CT, USA.
J Am Geriatr Soc. 2023 Sep;71(9):2935-2945. doi: 10.1111/jgs.18474. Epub 2023 Jun 19.
Virtual collaborative models are a practical way to implement a supportive environment for multi-team learning. In this project, we aimed to describe the processes and outcomes of a virtual deprescribing collaborative that facilitated implementation of deprescribing interventions around the country.
Two successive cohorts comprised of multidisciplinary teams from geographically diverse veterans affairs (VA) sites were selected via an application process to participate in a virtual deprescribing collaborative. Each site developed its own deprescribing protocol and took part in regular meetings, mentoring groups, monthly data reporting, and other learning activities over an approximate 9 month period, per cohort. Standard measures were number of veterans served and medications deprescribed. Descriptive and qualitative analyses were utilized.
Twenty-one total VA sites were selected to participate in the deprescribing collaborative in two cohorts (Cohort 1, n = 12 sites; Cohort 2, n = 9 sites). The majority of sites' practice areas directly served the older adult population, and the majority of site leads were pharmacists. The most utilized tool used by the collaborative sites was the VA VIONE decision support tool (n = 14) and the most common strategy was individualized medication review. Combining outcomes from both Cohorts 1 and 2, a total of n = 4770 veterans were served, with 8332 medications deprescribed. Eighty-two percent of Cohort 1 sites surveyed reported their deprescribing program was still being utilized after 1 year follow up.
This virtual deprescribing collaborative aided in the successful implementation of both established and novel deprescribing practices across a variety of VA practice sites that care for older adults. The shared learning experience enhanced problem solving and allowed for interdisciplinary teamwork. Overall the collaborative was successful in improving polypharmacy for several thousand older adults.
虚拟协作模型是实现多团队学习支持环境的一种实用方法。在本项目中，我们旨在描述一个虚拟减药协作项目的过程和结果，该项目促进了全国各地减药干预措施的实施。
通过申请程序，选择了两个由来自地理位置不同的退伍军人事务部（VA）站点的多学科团队组成的连续队列来参加虚拟减药协作。每个站点都制定了自己的减药方案，并参加了定期会议、指导小组、每月数据报告和其他学习活动，每个队列大约持续 9 个月。标准措施是服务的退伍军人人数和减药的药物数量。采用描述性和定性分析。
在两个队列（队列 1，n=12 个站点；队列 2，n=9 个站点）中，共有 21 个 VA 站点被选中参加减药协作。大多数站点的实践领域直接为老年人口服务，大多数站点负责人是药剂师。协作站点使用最多的工具是 VA VIONE 决策支持工具（n=14），最常用的策略是个体化药物审查。结合队列 1 和队列 2 的结果，共有 n=4770 名退伍军人得到服务，共减少 8332 种药物。队列 1 中 82%接受调查的站点报告说，在 1 年的随访后，他们的减药计划仍在使用。
这个虚拟减药协作项目在各种照顾老年人的 VA 实践站点成功地实施了既定和新的减药实践。共享的学习经验增强了问题解决能力，并允许跨学科团队合作。总的来说，该协作项目成功地改善了数千名老年人的多种药物治疗。
