Implementation of a Polypharmacy Deprescribing Protocol Among Older Adults in a Community-based Care Organization

Background: Polypharmacy, defined as the use of five or more medications, has the potential to increase morbidity, mortality and decrease quality of life. Older adults are disproportionately affected by polypharmacy. Decreasing polypharmacy could prevent morbidity and mortality while saving millions of dollars annually. The use of the ARMOR tool has been shown to decrease polypharmacy and the prescribing of inappropriate medications among the elderly. Local problem: There is a high prevalence of polypharmacy among older adult patients at the managed care organization where this quality improvement project was implemented. Among a panel of 30 members, almost all (n=29) were taking at least 10 medications. Methods: The ARMOR tool, was implemented using a polypharmacy deprescribing protocol among older adults in a community-based care organization. This quality improvement project tested the feasibility, acceptability, and effectiveness of the ARMOR tool among older adults enrolled in a managed care organization in Massachusetts. Older patients taking 10 or more medications were eligible for a multidisciplinary team-based review using the ARMOR tool. The ARMOR tool was used as a guide using sequential steps in deciding whether medications should be discontinued. Intervention: The ARMOR tool was used to enhance knowledge and deprescribe as necessary with primary care provider approval. During the twelve-week implementation, older adults taking 10 or more medications were screened using the ARMOR tool’s criteria. The clinical pharmacist was consulted as necessary. Results: Following the implementation of the ARMOR step by step process, there was a meaningful decrease in polypharmacy for those participants who could complete all phases of the tool. Thirty patients were deemed eligible for the pathway; 30% (n=9) were able to complete all phases of the ARMOR tool. Of these nine members, there was an 18 percent decrease in the number of medications prescribed. Summary: For those patients in whom the full ARMOR tool could be implemented; there was a clinically significant improvement in polypharmacy. However, in the majority of patients, clinicians were not able to complete the final step in the ARMOR tool which was to coordinate deprescribing with the PCP. Education about polypharmacy and organizational changes to partner with primary care providers around polypharmacy is needed