Interventions to Reduce High-Risk Medication Use in the Geriatric Population

Background: The Beers List is a guideline for health care workers to prescribe medications that are safe in the elderly. Using Beers List guidelines in the primary care setting, morbidity and mortality secondary to adverse effects, drug-drug interactions, and falls can be reduced significantly. Objective: To improve the quality and decrease the number of high-risk medications prescribed to the geriatric population through an interprofessional appointment approach. Methods: A prospective quality improvement project was completed over a 3-month period from August 2016 to November 2016 at a residency training outpatient family medicine clinic. Data on Medicare patients with 1 or more high-risk medication were obtained from the electronic health record (Allscripts NQF 0022). Participants were older than 65 years, with one or more high-risk medication as defined by Medicare. Patients were contacted for medication review appointments via phone and mail. The appointment was scheduled for a total of 60 minutes, with the initial 40 minutes spent with the pharmacy team for a comprehensive, medication reconciliation, and an assessment of their health literacy. Health literacy was assessed with the Short Assessment of Health Literacy. Recommendations for interventions by the interprofessional team were discussed and implemented during the last 20 minutes. Descriptive statistics and 2-sided dependent t tests were used to evaluate the data. Results: Thirty-four participants had a mean age of 74 years, 53% were male, 74% Caucasian, 24% African, and 2% Native Americans. Health literacy was good with only 20% below functional. The total high-risk medications dropped from 42 to 28, resulting in a 33% reduction of high-risk medications (P = .0005). There were 6 possible interventions with an average of 2 interventions per participant. The interventions were medication discontinuation for 11.39% (n = 8), changing medications for 7.25% (n = 5), medication reduced for 24.64% (n = 17), patients unwilling to change medications for 5.79% (n = 4), physicians deemed medication necessary for 14.5% (n = 10), and patient education for 36% (n = 25).