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Pharmacy and Pharmaceutical Sciences
Primary Author: Ling J. Zhan, PharmD
Co-Authors: Sharon Leigh, PharmD BCPS, Mary Beth Kuebrich, MS, AGPCNP-BC, Clara Mikhaeil, PharmD, BCPS, Colleen M. Casey, PhD, ANP-BC
Location: Providence Health & Services, Portland, Oregon
Title: Evaluating outcomes of medication-related interventions from the “Seniors At risk for Falls after Emergency Room visit” (SAFER) pilot project
Purpose: Falls are the leading cause of injury in older adults, resulting in decreased mobility, loss of independence, and increased health care costs. Even a single fall puts an older adult at higher risk for future falls. Despite numerous studies showing evidence that multifactorial fall risk interventions are effective in decreasing fall risk, even older adults who have an injurious fall often do not receive meaningful interventions to mitigate their fall risk. This study evaluated the impact of medication-related interventions for older adults who had a fall-related ED visit, as part of a larger study of multifactorial fall-risk interventions in the primary care setting.
Methods: This study was approved by the Providence-Oregon Institutional Review Board. This retrospective chart review studied a subset of patients enrolled in the SAFER pilot project who presented to an ED following a fall. Included patients were 75 years or older and taking at least one high-risk medication (HRM) that is associated with increased risk for falls. Patients were enrolled in the SAFER pilot from December 2018 to June 2019. Eligible patients received a comprehensive medication review by a clinical pharmacist; some also received a Geriatric consult that included medication recommendations. Medication recommendations were then forwarded to the clinic’s Primary Care Provider (PCP) and Registered Nurse for follow up. The parent study used a matched control design to compare SAFER interventions with usual care; this study did not include a comparison to the control group. Study outcomes included: overall burden of high-risk medications, number of high-risk medications discontinued or tapered, initiation of osteoporosis treatment or prevention measures, changes in blood pressure (BP) or hemoglobin A1c goals, and overall reduction in polypharmacy. The study also evaluated to what degree medication-related recommendations were adopted by the PCP over a minimum follow-up period of 7 months.
Results: Overall, 50 patients underwent chart review with 4 patients not meeting inclusion criteria; 46 patients were on HRM (average 4.3 HRM/person) and included in the final analysis.
Of those patients, 25 (54%) received a PharmD consult. For these 25 patients, 117 medication-related recommendations were made by the Geriatric and Clinical Pharmacy teams. Of those, a total of 52 (44%) changes were implemented by the PCP: 17 HRMs were discontinued, 9 taper/cross-tapered, and 17 osteoporosis-related initiated. BP and A1c goals on patient’s problem list were not clearly defined for 69% and 50% of patients, respectively.
Conclusion: Medication optimization and reduction of HRM was effective in patients receiving a PharmD consult. The most accepted recommendations included ordering DEXA, orthostatic BP testing, adding Vitamin D, and discontinuing opioids. Not every patient who qualified received a PharmD consult, suggesting that more medication changes could have been implemented had PharmDs been involved. The process of referring to a PharmD for a consult will need to be reviewed. Given that these patients are at high risk to fall, BP and A1c goals should be clarified and perhaps more lenient goals may be indicated. In addition, these results should be compared with the matched-control group of the parent study to determine the value of reducing HRM use in older patients at high risk of falls.
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2020
Providence Portland Medical Center, PGY-1 Pharmacy Residency Program
Zhan, Ling J.; Leigh, Sharon; Kuebrich, Mary E.; Mikhaeil, Clara; Hom, Kevin; and Casey, Colleen M., "Evaluating outcomes of medication-related interventions from the “Seniors At risk for Falls after Emergency Room visit” (SAFER) pilot project" (2020). Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020. 7.