Impact of an Educational Deprescribing Intervention on Provider Confidence and Polypharmacy in the Nursing Home

Outcomes 1. To gain knowledge about delivering provider education for internal palliative care programs focused on primary palliative care, polypharmacy and deprescribing. 2. To review the outcomes of this quality improvement project, including polypharmacy rate, provider confidence and knowledge, and experiences with deprescribing. Key Message Palliative care needs in the nursing home are significant and there is limited study about the education of providers focused on polypharmacy and deprescribing. This quality improvement project evaluates the impact of an educational deprescribing intervention on the polypharmacy rate, provider confidence and knowledge in this setting. Introduction There are significant palliative care needs in the nursing home population, and expert recommendations include training for internal palliative care programs (Ersek et al., 2022). Polypharmacy is commonly encountered, however provider barriers include deficits in deprescribing confidence and knowledge (Randles et al., 2022). Objective To measure the impact of an evidence based educational deprescribing intervention on polypharmacy rate, provider confidence and knowledge in the nursing home. Methods Using a quasi-experimental design, we invited providers working in 52 nursing homes with high polypharmacy rates to attend a live web-based educational intervention with focus on polypharmacy and deprescribing. The following measures were collected before and after the intervention: polypharmacy rate (average number of routine medications per patient), provider confidence level, and deprescribing knowledge. Results Twenty-one Nurse Practitioners and one Physician Assistant across 11 states participated in the intervention; 14% reported geriatric certification. Over 40% of the providers had been practicing for at least 5 years; 45% had been practicing for 1-5 years; and 14% had been practicing for less than one year. Provider confidence level related to deprescribing increased from 68.4% to 81.2% following a one-hour educational intervention. The polypharmacy rate three months after the intervention was 16% lower in centers where a provider had attended the training, compared to a 13% reduction in centers where a provider had not attended the training. There was no significant change in the deprescribing knowledge score. Additional qualitative data about experiences with and barriers to deprescribing were also collected. Conclusion The findings from this quality improvement demonstrate that an educational intervention focused on providers practicing in the nursing home setting can improve deprescribing confidence and reduce polypharmacy rates. These findings may be used to implement internal palliative care programs with training about primary palliative care and deprescribing strategies for patients living with serious illness. Keywords Workforce / Career Development; Quality Improvement