Abstract

Older adults, particularly those with multiple chronic diseases, geriatric syndromes and complex needs, often are prescribed multiple medications. They are at risk for adverse drug events stemming from complex medication use, which can result in acute care utilization, institutionalization and other long-term services use. In rural areas where expertise in geriatric care is often lacking, older adults are particularly at risk. Recently programs have been developed to reduce the number of medications, in a process known as “deprescribing”. This has yielded patient-level and system-level benefits, in particular, patient safety. The goal of this proposal is to disseminate widely, particularly in difficult to reach rural areas, a novel and effective deprescribing pharmacist-led program (VIONE) in order to improve medication use by deprescribing unnecessary and potential harmful medications using an established network of geriatric consultants and care teams. The aim of the planning proposal is to prepare for rigorous testing of dissemination strategies in phase two by: (1) Inviting stakeholders and key players to provide advice on the design of phase 2 proposal. (2) Planning for establishing a panel consisting of older Veterans, surrogate decision makers, caregivers, primary care and geriatrics teams in phase 2 proposal. (3) Utilize already collected information from the evaluation and implementation of GRECC Connect (Teleconsultation service) and VIONE (deprescribing clinical service) to inform the approach for phase 2 full proposal. (4) Develop and submit Phase II proposal armed with information from the planning activities in Aims 1-3 Phase 2 goals: We plan to test dissemination strategies utilizing information obtained from phase 1 activities to inform choices of strategies including tools to measure readiness for implementation, refine implementation toolkits to target barriers in local contexts, with the ultimate goal of planning and disseminating VIONE in the large network of VA medical centers and clinics serving rural Veterans. Innovation: The proposed study will advance the dissemination of an innovative program, VIONE, to improving medication use utilizing established networks. Because of the broad network through which dissemination and implementation occur, it necessitates a careful planning of implementation strategy, and tools that facilitates implementation and measures its adoption, adaptations, fidelity, reach, and effectiveness.

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DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems

DRE: TRL - Applied/Translational

Keywords: Best Practices, Medication Management, Practice Patterns/Trends

MeSH Terms: None at this time.