SRF014: Cost savings analysis of family medicine residency program-based deprescribing in two Midwestern nursing homes
Peter Kim, MD, MPH; Molly Wootten, BA; Matthew Arnold, PharmD, BCACP
CONTEXT: Reduction of polypharmacy via deprescribing is suggested to reduce adverse drug reactions and prevent polypharmacy-related complications in older adults. Potential cost savings related to deprescribing in the nursing home setting is less known. OBJECITVES: (1) To summarize the deprescribing process implemented at a community-based family medicine (FM) residency program in the care of nursing home (NH) patients; and (2) to study the potential total cost savings related to deprescribing in the nursing homes. STUDY DESIGN: Retrospective cost analysis and chart review of electronic medical records. SETTING: Two nursing homes. POPULATION STUDIED: NH patients whose primary care provider (PCP) was the FM resident physician. INTERVENTION: The faculty clinical pharmacist and FM resident physicians performed an on-site, one-on-one joint review of medication lists of patients due for 60-day Medicare NH visit. NH visits were made each month. The resident physician made the final decision to continue, taper, or discontinue medication. Two faculty family physicians were present at each nursing home for staffing and supervision. OUTCOME MEASURES: Available prices from GoodRx for prescription medications and Walmart store brand retail prices for over-the-counter medication were used to calculate annual net savings attributed to discontinued medications. RESULTS: Over a 21-month study period, a total of 425 medications were discontinued from 65 NH patients with a projected annual cost savings of $145,901.67. The majority of cost savings came from discontinuing brand name medications. FM residents in all levels (n = 24) of training engaged in deprescribing. EXPECTED OUTCOMES: An interdisciplinary deprescribing process implemented at a FM residency program in the care of NH patients resulted in a projected net annual cost savings related to medications. For FM residency and geriatric fellowship programs across the U.S., direct collaboration between PCP of NH patients and a pharmacist who advocates for deprescribing is likely needed for successful implementation of deprescription programs in the NH setting.