J Am Pharm Assoc (2003). 2024 Jan-Feb;64(1):139-145. doi: 10.1016/j.japh.2023.09.003. Epub 2023 Sep 16.
Polypharmacy, a broad term to describe the use of numerous and often unnecessary medications, has been connected to frailty, hospital admissions, falls, and even mortality. The Veterans Health Administration (VHA) developed the VIONE (vital, important, optional, not indicated, and every medication has an indication) dashboard to identify patients with polypharmacy and serve as a framework for deprescribing of medications across VHA facilities where it is used in a variety of practice settings by different disciplines.
This study aimed to describe the implementation of a pharmacist-led, system-wide, deprescribing initiative in the primary care setting.
Interdisciplinary education was provided through academic detailing. Subsequently, patients were identified for inclusion in the project using the VIONE dashboard focusing on those at highest risk of polypharmacy and moving down to the lowest risk. Interested patients underwent a medication reconciliation. A clinical pharmacist practitioner (CPP) then contacted the patient to discuss potential deprescribing options. Recommendations were relayed to the primary care provider (PCP) for final approval and communicated to the patient by the pharmacy team.
Primary care CPPs (n = 3) integrated deprescribing into their standard workload. This service was implemented in the primary care setting across an entire health care system consisting of 16 different primary care teams.
The initiative's impact was measured by the number of discontinued medications, the acceptance rate of recommendations by the PCP, the potential annualized cost avoidance, and the number of patients referred to CPP medication management clinics.
Among 63 patients, a total of 352 medications were deprescribed resulting in a potential annualized cost avoidance of $184,221. The acceptance rate of discontinuation recommendations was 96.7%. Subsequently, 25.4% of patients were referred to pharmacist-led clinics for disease state management.
Embedding deprescribing into standard CPP workflow within the primary care setting facilitated a way for polypharmacy reduction and allowed the expansion of pharmacy-led services at VA Butler Healthcare System.
多种药物治疗，一个广义的术语，描述了使用大量且往往不必要的药物，与虚弱、住院、跌倒甚至死亡有关。退伍军人健康管理局（VHA）开发了 VIONE（重要、必要、可选、不推荐和每种药物都有适应证）仪表板，以确定患有多种药物治疗的患者，并作为在 VHA 设施中减少药物治疗的框架，在各种实践环境中，不同学科都在使用。
本研究旨在描述在初级保健环境中实施的药剂师主导的、全系统的减药计划。
通过学术详细说明提供跨学科教育。随后，使用 VIONE 仪表板确定符合项目条件的患者，重点关注高风险的多种药物治疗患者，然后逐步降低风险。有兴趣的患者进行药物重新调整。然后，临床药剂师从业者（CPP）联系患者讨论潜在的减药选择。建议转达给初级保健提供者（PCP）进行最终批准，并由药剂团队告知患者。
初级保健 CPP（n=3）将减药纳入其标准工作量。该服务在整个医疗保健系统的 16 个不同的初级保健团队中实施。
通过停止使用的药物数量、PCP 对建议的接受率、潜在的年化成本避免以及转介给 CPP 药物管理诊所的患者数量来衡量该计划的影响。
在 63 名患者中，共停用了 352 种药物，潜在的年化成本避免了 184,221 美元。停止使用建议的接受率为 96.7%。随后，25.4%的患者被转介到药剂师主导的诊所进行疾病管理。
在初级保健环境中，将减药纳入标准 CPP 工作流程为减少多种药物治疗提供了一种方法，并允许在 VA Butler 医疗保健系统中扩展药剂师主导的服务。
