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.

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Jack 11/21/2020

our patients need us all to have a team approach to care. primary care can learn a lot from all our partners, including our patients. thanks for your study and work.

Claire Fletcher 11/21/2020

That is a significant reduction in cost, and many of those medications were on the Beers' list anyway. Enjoyed reading your poster!

Ranjit Singh 11/22/2020

Thanks so much for sharing this work. Deprescribing in the nursing home is such an important activity. Reducing pill burden has so many benefits in addition to cost savings.  Just reducing the number of pills can improve patient quality of life, and reduce staff time for pill administration. Not to mention the adverse effects. In these patients, it is common to blame a decline in function/cognition on the patient's underlying conditions and miss the fact that medications are contributing to that decline.  While nursing homes have consultant pharmacists (at least in the US), who do a good job of pointing out issues and opportunities to deprescribe, this is generally done asynchronously, with no interaction, As you point out, your approach was effective because of the real-time interaction at the time of the routine medical visit. We need to find ways to implement that more broadly,  Thanks again!

Barcey 11/23/2020

Great work, Peter! Glad you are keeping up with research projects!

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