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

Webinar Q and A

Pdf Summary

The document from HCCIntelligence addresses the concept of medication management and the process of deprescribing, highlighting various facets involved in both managing and stopping medications. <br /><br />**Multi Complexity:** Defined by the National Quality Forum as the presence of two or more chronic conditions adversely affecting a patient’s health, requiring complex healthcare management and coordination.<br /><br />**Deprescribing Proton Pump Inhibitors (PPIs):** For patients without a clear clinical indication for long-term PPI use, a gradual reduction approach is recommended. This can be accomplished by reducing the dose every 7-10 days until the lowest dose is reached, followed by discontinuation if the patient tolerates it well. Caution is advised to prevent a hyper-acidic response.<br /><br />**Patient Follow-Up:** The timing for follow-up after medication changes depends on the medication, the patient's personality, and needs. Informal methods, such as phone calls, can be sufficient to monitor progress and address any adverse reactions.<br /><br />**Handling Emotional Attachments to Medications:** Open-ended questions can facilitate discussions about reducing medications for patients and families who are emotionally attached. Persistent dialogue and documenting interactions can help manage the process, especially with medications like benzodiazepines, which are notably difficult to deprescribe.<br /><br />**Provider Reluctance:** Reluctance to deprescribe may stem from concerns about disrupting stable conditions, time constraints, adherence to guidelines, and the lack of ownership due to multiple specialists involved in a patient’s care.<br /><br />**Physician Burnout:** Burnout among healthcare providers is prevalent but taboo due to fears of appearing weak. Addressing burnout requires systemic changes, including workflow adjustments and supportive office environments, as well as personal strategies like adequate rest and exercise.<br /><br />**Specific Medication Guidance:** For medications like rivastigmine patches in dementia patients, gradual reduction and ongoing family dialogue are crucial. For antipsychotics, resources such as deprescribing.org offer protocols.<br /><br />**Calculating Renal Dosing:** The gold standard is creatinine clearance, though some medications use estimated glomerular filtration rate (EGFR) based on study data. It is important to reference specific dosing guidelines provided by drug manufacturers.<br /><br />This summary encapsulates the key points discussed in the webinar about managing and deprescribing medications, highlighting challenges, strategies, and specific protocols for healthcare providers.

Keywords

medication management

deprescribing

chronic conditions

proton pump inhibitors

patient follow-up

emotional attachment

provider reluctance

physician burnout

renal dosing

specific medication guidance