1. Using an EHR Template and the Beer’s List to Address Geriatric Polypharmacy Rose Family Medicine Residency Emily Gutgsell, MD Emma Bjore, MD Anna Plunkett, MD Lindsay Stiede, DO Laura Webster, MD 1

2. Disclosures I do not have any financial disclosures 2

3. Polypharmacy? 3

4. Background Polypharmacy – more meds than necessary 4 Negative outcomes 4 – Drug reactions / interactions – ↓Adherence – Urinary Incontinence – Impaired Cognition – Impaired Balance 4

5. Background : Geriatric 20-25% hospital admissions in 65+ related to ADE 3 Multiple chronic health conditions, specialists Decreased metabolism of drugs Beer’s List identifies drugs with potential toxicity, limited effectiveness Primary Care is the frontline to address this issue 5

6. More Medications, More Adverse Drug Events 6 Prybys et al 2002 (1)

7. Objectives To use EHR template to improve patient care Identify barriers to med compliance Help providers and patients identify goals to prevent adverse events Decrease doses, eliminate PIM’s Protect patients from hazards of medicine 7

8. Methods Where: Rose Family Medicine Residency Clinic. When: February 1 – April 1, 2016 Who: Adults age 65+ taking 7 or more medications, including supplements. What: EHR template, provider education, patient education How: Chart review of 22 patients fitting the criteria, with the ICD 10 diagnostic codes Polypharmacy, At risk for polypharmacy, or At risk for adverse drug event 8

9. Rose Family Medicine Clinic 9 Community-based, university-affiliated, urban residency clinic Seven faculty physicians, one PA, and 18 resident providers No clinical pharmacist during time of study

10. 10 Opening the discussion

11. Treatment Goals 11 Self-Management Goals

12. Results Minimal, mixed, in terms of de-prescribing Deferring to future visits Conversation has begun for at least 22 patients 12

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14. Increased Awareness 14

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17. Lessons Learned Caveat: not a high powered study Changes can happen even in one visit Providers and patients want the same things EHR template could be an effective way of prompting and documenting 17

18. Next steps Continue to collect data Involve our Clinical Pharmacist Continue to educate providers, patients Invite provider, patient feedback 18

19. Questions? 19

20. Contact Information Emily Gutgsell, MD emily.gutgsell@healthonecares.com 20

21. References 1.Prebys, K., Melville, K., Hanna, J., Gee, A., & Chyka, P. (2002). Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1: Overview, etiology, and drug interactions. Emergency Medicine Reports, 23(11), 145-153. 2.Campanelli, Christine M., American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2012 Apr; 60(4): 616–631. 3.Fulton, M., Allen, E. (2005). Polypharmacy in the Elderly: A Literature Review. Journal of the American Academy of Nurse Practitioners, 17(4), 123-132 4.Patterson, Cadogan, Jerse, Cardwell, Bradley, Ryan, Hughes. (2014). Interventions to improve the appropriate use of polypharmacy for older people (Review). The Cochrane Collaboration, The Cochrane Library 2014, Issue 10. 5.Hanlon, et al. 1996. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. American Journal of medicine. Volume 100, Issue 4. 6.Zarowitz, B, et al. 2012. Reduction of High-Risk Polypharmacy Drug Combinations in Patients in a Managed Care Setting. Pharmacotherapy. Volume 25, issue 11. 21

22. Special thanks to Stephanie Henderson Daniel Topp 22