Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic

Introduction Polypharmacy is a concern among older adults. An academic medical center in northeast Ohio currently has an outpatient geriatric medicine clinic with an embedded board-certified geriatric pharmacist who performs comprehensive medication management for older adults under a collaborative...

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Main Authors: Antonietta Paneccasio, Anna Bondar, Emily Fargo, Marcie Parker, Ardeshir Hashmi, Kenneth Koncilja, Gina Elder
Format: Article
Language:English
Published: Taylor & Francis Group 2025-12-01
Series:Health Literacy and Communication Open
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Online Access:https://www.tandfonline.com/doi/10.1080/28355245.2025.2459207
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author Antonietta Paneccasio
Anna Bondar
Emily Fargo
Marcie Parker
Ardeshir Hashmi
Kenneth Koncilja
Gina Elder
author_facet Antonietta Paneccasio
Anna Bondar
Emily Fargo
Marcie Parker
Ardeshir Hashmi
Kenneth Koncilja
Gina Elder
author_sort Antonietta Paneccasio
collection DOAJ
description Introduction Polypharmacy is a concern among older adults. An academic medical center in northeast Ohio currently has an outpatient geriatric medicine clinic with an embedded board-certified geriatric pharmacist who performs comprehensive medication management for older adults under a collaborative practice agreement. With polypharmacy as a primary referral reason, this pharmacist focuses on resolving drug-related problems (DRPs) and deprescribing.Aims The primary objective of this study was to describe the DRPs identified by the pharmacist for older adults referred for polypharmacy. Secondary objectives included: describing the DRPs resolved by the pharmacist, identifying the medications deprescribed, determining the frequency of additional outreach to other healthcare providers or patient caregivers, and characterizing any additional pharmacist interventions. This study aimed to determine the benefits of the expansion of geriatric pharmacy services.Methods This was a single-center, non-interventional, retrospective study. Patients were included if referred to geriatric ambulatory clinic pharmacy services for polypharmacy and completed an initial visit with the pharmacist between September 1, 2021, and August 31, 2022. Baseline characteristics and study outcomes were analyzed using descriptive statistics.Results A total of 137 patients were included for analysis, and a notable 82% of the study population had cognitive impairment documented. During the 137 initial visits with the pharmacist, 494 DRPs were identified, and more than half of these were resolved during the initial visit. All visits resulted in at least one pharmacist intervention. The most common DRP identified was unnecessary drug therapy (38.6%). Of the 313 medications identified as eligible for deprescribing, about half were deprescribed by the pharmacist during the initial visit. Of the 133 additional pharmacist interventions, medication education was the most common (52%).Discussion The results of this study emphasize the benefit of comprehensive medication management with a focus on deprescribing for an older adult population with polypharmacy, the majority of whom had cognitive impairment.
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spelling doaj-art-723486bbb0ce4ecba20a7abe753a5e4c2025-02-03T07:25:54ZengTaylor & Francis GroupHealth Literacy and Communication Open2835-52452025-12-013110.1080/28355245.2025.2459207Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinicAntonietta Paneccasio0Anna Bondar1Emily Fargo2Marcie Parker3Ardeshir Hashmi4Kenneth Koncilja5Gina Elder6Department of Pharmacy, Cleveland Clinic Foundation, Medina, Cleveland, USADepartment of Pharmacy, Cleveland Clinic Foundation, Medina, Cleveland, USADepartment of Pharmacy, Cleveland Clinic Foundation, Medina, Cleveland, USADepartment of Pharmacy, Cleveland Clinic Foundation, Medina, Cleveland, USADepartment of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Medina, Cleveland, USADepartment of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Medina, Cleveland, USADepartment of Pharmacy, Cleveland Clinic Foundation, Medina, Cleveland, USAIntroduction Polypharmacy is a concern among older adults. An academic medical center in northeast Ohio currently has an outpatient geriatric medicine clinic with an embedded board-certified geriatric pharmacist who performs comprehensive medication management for older adults under a collaborative practice agreement. With polypharmacy as a primary referral reason, this pharmacist focuses on resolving drug-related problems (DRPs) and deprescribing.Aims The primary objective of this study was to describe the DRPs identified by the pharmacist for older adults referred for polypharmacy. Secondary objectives included: describing the DRPs resolved by the pharmacist, identifying the medications deprescribed, determining the frequency of additional outreach to other healthcare providers or patient caregivers, and characterizing any additional pharmacist interventions. This study aimed to determine the benefits of the expansion of geriatric pharmacy services.Methods This was a single-center, non-interventional, retrospective study. Patients were included if referred to geriatric ambulatory clinic pharmacy services for polypharmacy and completed an initial visit with the pharmacist between September 1, 2021, and August 31, 2022. Baseline characteristics and study outcomes were analyzed using descriptive statistics.Results A total of 137 patients were included for analysis, and a notable 82% of the study population had cognitive impairment documented. During the 137 initial visits with the pharmacist, 494 DRPs were identified, and more than half of these were resolved during the initial visit. All visits resulted in at least one pharmacist intervention. The most common DRP identified was unnecessary drug therapy (38.6%). Of the 313 medications identified as eligible for deprescribing, about half were deprescribed by the pharmacist during the initial visit. Of the 133 additional pharmacist interventions, medication education was the most common (52%).Discussion The results of this study emphasize the benefit of comprehensive medication management with a focus on deprescribing for an older adult population with polypharmacy, the majority of whom had cognitive impairment.https://www.tandfonline.com/doi/10.1080/28355245.2025.2459207Polypharmacydeprescribinggeriatricsdrug related problems
spellingShingle Antonietta Paneccasio
Anna Bondar
Emily Fargo
Marcie Parker
Ardeshir Hashmi
Kenneth Koncilja
Gina Elder
Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic
Health Literacy and Communication Open
Polypharmacy
deprescribing
geriatrics
drug related problems
title Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic
title_full Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic
title_fullStr Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic
title_full_unstemmed Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic
title_short Pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic
title_sort pharmacist interventions for older adults with polypharmacy in an ambulatory geriatric clinic
topic Polypharmacy
deprescribing
geriatrics
drug related problems
url https://www.tandfonline.com/doi/10.1080/28355245.2025.2459207
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