Assessing an Interprofessional Polypharmacy and Deprescribing Educational Intervention for Primary Care Post-graduate Trainees: a Quantitative and Qualitative Evaluation

Abstract

Background: Polypharmacy and potentially inappropriate medications (PIMs) are increasingly common and associated with adverse health effects. However, post-graduate education in polypharmacy and complex medication management for older adults remain limited.

Objective: The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE) polypharmacy clinic was created to provide a platform for teaching internal medicine (IM) and nurse practitioner (NP) residents about outpatient medication management and deprescribing for older adults. We aimed to assess residents' knowledge of polypharmacy and perceptions of this interprofessional education intervention.

Design: A prospective cohort study with an internal comparison group.

Participants: IM residents and NP residents; Veterans ≥ 65 years and taking ≥ 10 medications.

Intervention: IMPROVE consists of a pre-clinic conference, shared medical appointment, individual appointment, and interprofessional precepting model.

Main measures: We assessed residents' performance on a pre-post knowledge test, residents' qualitative assessment of the educational impact of IMPROVE, and the number and type of medications discontinued or decreased.

Key results: The IMPROVE intervention group (n = 18) had a significantly greater improvement in test scores than the control group (n = 18) (14% ± 15% versus - 1.3% ± 16%) over a period of 6 months (Wilcoxon rank sum, p = 0.019). In focus groups, residents (n = 17) reported perceived improvements in knowledge and skills, noting that the experience changed their practice in other clinical settings. In addition, residents valued the unique interprofessional experience. Veterans (n = 71) had a median of 15 medications (IQR 12-19), and a median of 2 medications (IQR 1-3) was discontinued. Vitamins, supplements, and cardiovascular medications were the most commonly discontinued medications, and cardiovascular medications were the most commonly decreased in dose or frequency.

Conclusions: Overall, IMPROVE is an effective model of post-graduate primary care training in complex medication management and deprescribing that improves residents' knowledge and skills, and is perceived by residents to influence their practice outside the program.

Keywords: geriatrics; interprofessional education; medication management; polypharmacy; primary care.

Figure 1

Initiative to Minimize Pharmaceutical Risk in Older Veterans educational intervention design using experiential learning theory. Intervention learning activities are mapped to the learning cycle outlined by Armstrong’s adaptation of the Kolb experiential learning theory.

Figure 2

Performance on 12-item knowledge test. Blue bars indicate the mean test score at baseline for each group and red bars indicate the mean score at 6-month follow-up. Error bars represent standard deviation.