(P24) Impact of Education Campaign on Deprescribing

Objective/Aim: Polypharmacy is common in the nursing home population. Deprescribing programs generally result in 20-30% reductions in the targeted medications. Three categories of medications were chosen for this deprescribing initiative: anticholinergic bladder agents, proton pump inhibitors, and dementia medications including cholinesterase inhibitors and memantine. Anticholinergic bladder agents have high risks for confusion as well as low efficacy (1 less incontinent episode per day). Proton pump inhibitors are associated with hip fractures with long-term use. Dementia medications have low efficacy (1 point improvement in MMSE with cholinesterase inhibitors, which is not clinically significant) and the medications are not indicated for end of life, severe dementia, or dependent for care. We developed a robust educational program to assist with the deprescribing initiative.

Design/Methodology: A targeted list of each category of medications from Part D claims data (from the past three months) was distributed to the advance practice clinicians (APC). Each APC reviewed a short power point session that contained information on each medication class including mechanism of action, side effects, safer alternatives (including non-pharmacologic approaches), appropriate indications, efficacy, drug interactions, and how to taper the medication. They also reviewed an algorithm with a step-by-step approach to deprescribing each category of medications as well as two podcasts demonstrating how to have a deprescribing conversation with the patient and/or family as well as the primary care physician. All these resources were available online.  The APCs had two months to address each category of medication.

Results: The results were analyzed at the end of the eight-month initiative. Of the 398 patients on anticholinergic bladder agents, 201 (51%) were discontinued, 83 (21%) were changed to mirabegron, and 114 (28%) had no change. Of the 3209 patients on PPIs, 1132 (35%) were deprescribed, and 666 (21%) had a dose reduction. Of the 1411 (44%) who had no change only 9% were due to primary care physician refusal, 4% due to patient refusal, and 2% due to family refusal. Of the 500 functionally dependent patients with dementia, 182 (36%) were deprescribed; of the 2384 patients with dementia desiring comfort care, 657 (28%) were deprescribed.

Conclusion/

Discussion: The educational component of the deprescribing initiative gave the APCs both confidence in presenting their recommendations to the primary care providers, patients, and their families as well as a systematic approach to gradual dose reduction. For anticholinergic bladder agents and PPIs, the rate of discontinuation or dose reduction was greater than 50%, which exceeded the expected 30% average deprescribing rates. We attribute the success of the initiative to the education the APCs received. Next steps are to use this educational framework to address additional categories of medications including more than class of medications at a time.