HCCIntelligence™ Webinar Recording: Medication Management: Art of Deprescribing Medications in HBPC

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The "Art of Deprescribing in Home-Based Primary Care (HBPC)" webinar, hosted on March 18, 2020, by Dr. Paul Chiang, Senior Medical and Practice Advisor at the Home Centered Care Institute (HCCI), focused on strategies to manage and reduce polypharmacy in elderly patients. <br /><br />**Key Objectives:**<br />1. Highlight the importance of appropriate prescribing to minimize unnecessary medication in at-risk populations.<br />2. Present evidence-based methods for deprescribing, reducing polypharmacy, and breaking the prescribing cascade.<br />3. Identify barriers to medication adherence.<br /><br />**Polypharmacy Concerns:**<br />- Elderly patients, although only 13% of the U.S. population, consume about 33% of prescription medications.<br />- A significant percentage of these patients receive unnecessary medications, leading to adverse drug events in at least 15% of cases, contributing to ill health and hospitalizations.<br />- Challenges include managing multiple chronic conditions, physical and physiological impairments, and exclusion from many clinical studies.<br /><br />**Deprescribing Process:**<br />Deprescribing involves a systematic approach to discontinue medications where the potential for harm outweighs the benefits. It emphasizes shared decision-making aligned with the patient's care goals, functioning levels, life expectancy, and preferences.<br /><br />**Deprescribing Algorithm:**<br />1. **Reconciling** all medications, including prescriptions, over-the-counter drugs, and supplements.<br />2. **Reviewing** risks using criteria like Beers and STOPP, alongside patient-specific factors.<br />3. **Assessing** each drug to see if it can be discontinued based on indications, potential prescribing cascades, or being a burdensome prevention.<br />4. **Prioritizing** drugs for discontinuation based on potential harm and ease of cessation.<br />5. **Implementing** the plan with close monitoring and anticipatory guidance.<br /><br />**Case Study:**<br />An 82-year-old female with severe COPD and CHF was highlighted, illustrating the deprescribing process. Over eight months of home care, medication review, adjustments, and the transition to hospice, the patient's emergency visits and hospitalizations significantly decreased, supporting her goals of care.<br /><br />**Guidelines:**<br />- Beers Criteria and STOPP criteria provide frameworks for identifying potentially inappropriate medications in older adults.<br /><br />The webinar underscored that deprescribing is not about denying necessary care but rather about optimizing treatment to align with the patient's goals while minimizing adverse reactions and ensuring effective medication management.

Keywords

Deprescribing

Polypharmacy

Elderly Patients

Home-Based Primary Care

Medication Adherence

Adverse Drug Events

Beers Criteria

STOPP Criteria

Chronic Conditions

Patient-Centered Care