Utilization of the Polypharmacy VIONE Tool for Deprescribing in Geriatric Veterans

Abstract

Specific Aims: To determine the impact that the Polypharmacy VIONE (Vital, Important, Optional, Not indicated, Every medication has a diagnosis) tool has on number and types of medications deprescribed, deprescribing reasons, and annualized cost avoidance. Methods: Patients were identified during their outpatient appointment and offered the opportunity to undergo deprescribing with VIONE if they were at least 65 years old, taking 15 or more medications, and seen for primary or palliative care in the Phoenix VA Ambulatory Care Clinic. A retrospective chart review was conducted to identify patients with VIONE documented in the electronic health record between November 1, 2019 and February 28, 2021. Data were exported to an Excel spreadsheet for analysis. Mean and standard deviation (SD) were calculated for patient age. Median and interquartile range (IQR) were calculated for annualized cost avoidance. Frequencies and percentages were calculated for patient sex, race/ethnicity, drug class, and deprescribing reason. Main Results: Final analysis included 252 patients with 771 medications deprescribed. Mean age was 80 years (SD 8), 244 (96.8%) were male, and 181 (71.8%) were Caucasian. Top deprescribed drug classes were vitamins/supplements (15%) and antihypertensives (10.2%). Most common reasons for deprescribing were patient reported no longer taking (51.4%) and medication not indicated (25.3%). Median annualized cost avoidance was $29.35 (IQR $91.25). Conclusions: The VIONE deprescribing tool is effective in reducing polypharmacy in geriatric veterans of outpatient primary and palliative care settings. Additional studies are needed to assess the tool’s impact in other healthcare settings and older adult populations.