Population Health Approach to Optimizing Medications in Older Adults

Launched by CEDARS-SINAI MEDICAL CENTER · Oct 26, 2023

Keywords

ClinConnect Summary

This clinical trial, called the "Population Health Approach to Optimizing Medications in Older Adults," aims to explore how to safely reduce the number of medications older adults take, especially those at high risk for side effects from polypharmacy, which means taking multiple medications at once. The study will involve older adults aged 65 and over who are part of the Cedars-Sinai Health System and are identified as being at higher risk for medication-related issues based on their health records. Participants will be randomly assigned to one of four groups: two groups will receive interventions focused on managing their medications, while the other two groups will not receive these interventions.

To be eligible for this study, participants must be 65 years or older, have a primary care doctor in the Cedars-Sinai system, and be part of specific health programs like Medicare Advantage. They should also have a diagnosis of mild cognitive impairment or dementia if they are placed in one of the intervention groups. Participants can expect to work closely with healthcare professionals to review and possibly adjust their medications to improve their health. It's important to note that patients with certain conditions, like active substance use disorders or recent consultations with pharmacists about their medications, will not be eligible for this study. The trial is not yet recruiting participants but aims to contribute valuable insights into managing medications for older adults effectively.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients will be invited to enroll in the study if they are in the top decile of risk selected by a risk prediction model of polypharmacy-related adverse events. The risk prediction model includes variables such as: age, sex, recent healthcare encounters, current and past medications, current and past lab tests, current and past diagnoses.
• • 65 years of age or older
• • Have a primary care clinician within the Cedars-Sinai Health System who uses MyCSLink (electronic health record used by Cedars-Sinai).
• • Part of a Cedars-Sinai Health System population health registry (e.g., enrolled in an Accountable Care Organization, Medicare Advantage plan, or Primary Care First program)
• • Diagnosis of Mild Cognitive Impairment or Dementia at baseline (for one intervention group) on the problem list
• Exclusion criteria include:
• • Patients for whom there is an active substance use disorder (defined by a physician) and thus for whom the intervention may not be appropriate
• • Patients with an organ transplant
• • Visits with a Cedars-Sinai Medical Center pharmacist for a polypharmacy consult within the last 6 months
• • Patients who previously indicated in the EHR that they wish to opt out of participating in research studies.
• • Patients enrolled in CS360, a program for highly complex medical patients, who already receive polypharmacy services.