Deprescribing proton pump inhibitors, benzodiazepines, antipsychotics, and antihyperglycemic medications in a rural clinic in an elderly population
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Background: Polypharmacy affects many patients as they age and develop multiple health problems. The increased number of medications has been directly related to adverse drug events (ADEs) which include overdoses, falls, diarrhea, or insomnia. A panel of experts at the Bruyère Research Institute identified four classes of medications (proton pump inhibitors [PPIs], benzodiazepines receptor agonists [BZRAs], antipsychotics [ASs], and antihyperglycemics [AGs]), which are especially problematic in the elderly. They created four algorithms to help evaluate the necessity of these medications and offer suggestions for deprescribing them. Aim: The aim of this project was to decrease the unnecessary use of PPIs, BZRAs, ASs and AGs among the elderly by using the Bruyère algorithm and to increase provider deprescribing self-efficacy scores. Methods: This quality improvement project was conducted in a small rural community clinic in Northwest Montana. Two nurse practitioners (NPs) were involved. A survey was filled out by both the NPs at the beginning and the end of the project to assess their self-reported self- efficacy. A brief description of the Bruyère algorithm was provided to the NPs. This algorithm was then applied over a ten-week period to all patients over the age of 60 who had been previously prescribed the medications of interest. The rates of deprescribing as well as changes in provider self-efficacy scores (SES) were measured at the end of the project. Results: A total of 29 patients were encountered during the project. Ten of the patients were on a PPI and one was on a BZRA. None of the patients screened were on any of the other two classes of medications. At the end of the project, none of the targeted medications were discontinued, although PPI dosing was decreased from twice daily to daily in two patients. Overall, provider self-efficacy scores improved by 15% during the intervention period. Conclusions: The deprescribing algorithms likely improved provider self-efficacy scores and may reduce the medication burden faced by patients over the age of 60.