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Randomized Controlled Trial
. 2024 Jul;72(7):1973-1984.
doi: 10.1111/jgs.18867. Epub 2024 Mar 15.

Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study

Ariel R Green  1 , Rosalphie Quiles  1 , Andrea E Daddato  2 , Jessica Merrey  3 , Linda Weffald  2   4 , Kathy Gleason  2 , Qian-Li Xue  1   5 , Meghan Swarthout  3 , Scott Feeser  6 , Cynthia M Boyd  1 , Jennifer L Wolff  1   7 , Marcela D Blinka  1   5 , Anne M Libby  8 , Rebecca S Boxer  9
Affiliations
Randomized Controlled Trial

Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study

Ariel R Green et al. J Am Geriatr Soc. 2024 Jul.

Abstract

Background: People living with dementia (PLWD) have complex medication regimens, exposing them to increased risk of harm. Pragmatic deprescribing strategies that align with patient-care partner goals are needed.

Methods: A pilot study of a pharmacist-led intervention to optimize medications with patient-care partner priorities, ran May 2021-2022 at two health systems. PLWD with ≥7 medications in primary care and a care partner were enrolled. After an introductory mailing, dyads were randomized to a pharmacist telehealth intervention immediately (intervention) or delayed by 3 months (control). Feasibility outcomes were enrollment, intervention completion, pharmacist time, and primary care provider (PCP) acceptance of recommendations. To refine pragmatic data collection protocols, we assessed the Medication Regimen Complexity Index (MRCI; primary efficacy outcome) and the Family Caregiver Medication Administration Hassles Scale (FCMAHS).

Results: 69 dyads enrolled; 27 of 34 (79%) randomized to intervention and 28 of 35 (80%) randomized to control completed the intervention. Most visits (93%) took more than 20 min and required multiple follow-up interactions (62%). PCPs responded to 82% of the pharmacists' first messages and agreed with 98% of recommendations. At 3 months, 22 (81%) patients in the intervention and 14 (50%) in the control had ≥1 medication discontinued; 21 (78%) and 12 (43%), respectively, had ≥1 new medication added. The mean number of medications decreased by 0.6 (3.4) in the intervention and 0.2 (1.7) in the control, reflecting a non-clinically meaningful 1.0 (±12.4) point reduction in the MRCI among intervention patients and a 1.2 (±12.9) point increase among control. FCMAHS scores decreased by 3.3 (±18.8) points in the intervention and 2.5 (±14.4) points in the control.

Conclusion: Though complex, pharmacist-led telehealth deprescribing is feasible and may reduce medication burden in PLWD. To align with patient-care partner goals, pharmacists recommended deprescribing and prescribing. If scalable, such interventions may optimize goal-concordant care for PLWD.

Keywords: dementia; deprescribing; primary care.

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Conflict of interest statement

This study was funded by the National Institute on Aging (NIA) of the National Institutes of Health under Award Number U54AG063546, which funds NIA Imbedded Pragmatic Alzheimer’s and AD-Related Dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory). In addition, Dr. Boyd was supported by grant No. R24AG064025 (US Deprescribing Research Network). Dr. Boyd was also supported by K24AG056578 and Dr. Green by R01AG077011 from the National Institute on Aging. Dr. Boyd reported receiving royalties from UpToDate for writing a chapter on multi-morbidity and honoraria from Dynamed for reviewing a chapter on falls outside the submitted work. No other disclosures were reported.

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