Download Full Text (851 KB)

Publication Date



oregon; portland; milwaukie


Medical Education | Pharmacy and Pharmaceutical Sciences



• Geriatric patients are likely to experience adverse drug events related to high-risk medication use. Polypharmacy is also common and has a significant impact on the health of older adults. •The American Geriatric Society Beers Criteria lists potentially inappropriate medications for older adults.1 •Current literature suggests that Implementing interventions and deprescribing practices have a role in reducing costly hospitalizations. •STOPP (Screening Tool of Older People’s Prescriptions) was designed to address polypharmacy.2 •Medication review and follow-up services for older, polypharmacy patients lowered medication-related costs.3 •Projections suggest there is an insufficient supply of geriatrician services.4 •Per person personal health care spending for people 65 years and older is three times higher than spending per working-age adult.4 •Individuals aged 65 and older are expected to increase from 14.5 percent of the U.S. population in 2014 to 21.7 percent by 2040.5 •In 2018, a Geriatric Mini-Fellowship Program was implemented. The program was designed to: •Increase primary care provider competencies in managing geriatric syndromes. •Train PCP’s to be geriatric medicine leaders to share awareness of geriatric care in their respective clinics. •The program curriculum focused on the “Four M’s” of geriatric care. •Medication, Mobility, Mentation, What Matters •Two cohorts of fellows have graduated from the program.


• Quantify the prescribing pattern changes of high-risk medications of the geriatric fellows before and after completing the program. •Identify the geriatric fellows’ perceptions on deprescribing after completing the program.

Study Design

• Four high-risk medication drug classes were identified for an increased fall risk and were selected for this study.1 •Urinary Agents, Tricyclic Antidepressants, Muscle Relaxants, and Z-drugs •Study Period •May 2017 to May 2020 •Fellowship Cohort 1: Start Date April 16, 2018 •Pre-intervention: As of May 2018 •Post-intervention: As of May 2019 •Fellowship Cohort 2: Start Date April 20, 2019 •Pre-intervention: As of May 2019 •Post-intervention: As of May 2020 •Inclusion Criteria •Adults aged 65 years and older •Enrolled in the outpatient care of a geriatric fellow •Participated in at least one PCP office visit in the pre-intervention period and one visit in the post-intervention period. •Primary Endpoints •Number of patients on a high-risk medication in the identified classes •Number of high-risk medications in the Pre period •Number of high-risk medications in the Post period


Conclusions High-Risk Medication Data: •For most drug classes studied, deprescribing occurred more often than new starts. •Continuing high-risk medication use was very common across all drug classes. Chart Review Data: •The retrospective chart review identified cases of deprescribing that were not captured in the initial analysis. •Dose decrease occurred more often than dose increases. Qualitative Survey Data: •Geriatric fellowship respondents felt that they frequently attempted to deprescribe high-risk medications in older adults. Limitations •Randomized selection of continued high-risk medication cases only estimates the distribution of the population. •Limited number of primary care providers participating in the program. Data can easily be skewed by the practice of individual providers. •The degree of life-limiting illness or patient life expectancy was not identified and would influence the potential for a medication to be inappropriate.6 •The cost impact of the Geriatric Mini-Fellowship program cannot be calculated from the results of this study. •Literature suggests that deprescribing interventions implement in patients with limited life expectancy have potential for mortality reduction and cost savings.6

Future Steps

• Identify a method for obtaining a control group. • Compare prescribing pattern of primary care providers before and after participation in the Geriatric Mini-Fellowship. •Describe the impact of the program on patient outcomes and cost. •Investigate prescribing of other high-risk medication classes. •Develop a plan to target high-risk medications that are considered most difficult to deprescribe.




Primary Care


Graduate Medical Education

Conference / Event Name

Academic Achievement Day, 2021


Providence Milwaukie Hospital

Impact of the Geriatric Mini-Fellowship on Prescribing Patterns of the Primary Care Providers