Volume 71, Issue 9 p. 2935-2945
MODELS OF GERIATRIC CARE, QUALITY IMPROVEMENT, AND PROGRAM DISSEMINATION

A virtual breakthrough series collaborative to support deprescribing interventions across Veterans Affairs healthcare settings

Kristin K. Phillips PharmD

Corresponding Author

Kristin K. Phillips PharmD

Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

Correspondence

Kristin K. Phillips, 2215 Fuller Road (11G), Ann Arbor, MI 48105, USA.

Email: [email protected]

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Marcia C. Mecca MD

Marcia C. Mecca MD

VA Connecticut Healthcare System, West Haven, CT, USA

Yale School of Medicine, New Haven, CT, USA

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Abigail M. Baim-Lance PhD

Abigail M. Baim-Lance PhD

Geriatric Research, Education, and Clinical Center (GRECC), James J Peters Bronx VA Medical Center, Bronx, NY, USA

Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Icahn School of Medicine at Mount Sinai, New York, NY, USA

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Gabrielle S. Schiller MPH

Gabrielle S. Schiller MPH

Icahn School of Medicine at Mount Sinai, New York, NY, USA

CUNY Graduate School of Public Health and Health Policy, New York, NY, USA

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Jennifer A. Pruskowski PharmD, MS

Jennifer A. Pruskowski PharmD, MS

Geriatric Research, Education, and Clinical Center (GRECC), Pittsburgh Veteran Affairs Healthcare System, Pittsburgh, PA, USA

Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA

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Elizabeth C. Ellis PharmD

Elizabeth C. Ellis PharmD

VA Eastern Colorado Health Care System, Aurora, CO, USA

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Deylen S. Aponte-Rosario PharmD

Deylen S. Aponte-Rosario PharmD

Central Texas Veterans Health Care System, Temple, TX, USA

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Amanda L. Federovich-Hogan DNP

Amanda L. Federovich-Hogan DNP

Geriatric Research, Education, and Clinical Center (GRECC), Pittsburgh Veteran Affairs Healthcare System, Pittsburgh, PA, USA

VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

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Annette C. Kossifologos PharmD

Annette C. Kossifologos PharmD

Edward Hines, Jr. VA Hospital, USA

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Erica D. Martinez BA

Erica D. Martinez BA

Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA

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Kenneth S. Boockvar MD, MS

Kenneth S. Boockvar MD, MS

Department of Medicine—Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA

Birmingham VA Health Care System, Birmingham, AL, USA

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First published: 19 June 2023

Abstract

Background

Virtual collaborative models are a practical way to implement a supportive environment for multi-team learning. In this project, we aimed to describe the processes and outcomes of a virtual deprescribing collaborative that facilitated implementation of deprescribing interventions around the country.

Methods

Two successive cohorts comprised of multidisciplinary teams from geographically diverse veterans affairs (VA) sites were selected via an application process to participate in a virtual deprescribing collaborative. Each site developed its own deprescribing protocol and took part in regular meetings, mentoring groups, monthly data reporting, and other learning activities over an approximate 9 month period, per cohort. Standard measures were number of veterans served and medications deprescribed. Descriptive and qualitative analyses were utilized.

Results

Twenty-one total VA sites were selected to participate in the deprescribing collaborative in two cohorts (Cohort 1, n = 12 sites; Cohort 2, n = 9 sites). The majority of sites' practice areas directly served the older adult population, and the majority of site leads were pharmacists. The most utilized tool used by the collaborative sites was the VA VIONE decision support tool (n = 14) and the most common strategy was individualized medication review. Combining outcomes from both Cohorts 1 and 2, a total of n = 4770 veterans were served, with 8332 medications deprescribed. Eighty-two percent of Cohort 1 sites surveyed reported their deprescribing program was still being utilized after 1 year follow up.

Conclusions

This virtual deprescribing collaborative aided in the successful implementation of both established and novel deprescribing practices across a variety of VA practice sites that care for older adults. The shared learning experience enhanced problem solving and allowed for interdisciplinary teamwork. Overall the collaborative was successful in improving polypharmacy for several thousand older adults.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.