South Peace Polypharmacy Reduction Project: Impact Evaluations of Medication Reviews and Online Workshops in Rural British Columbia

Background: The South Peace Polypharmacy Reduction Project is a quality improvement initiative in three communities in rural British Columbia, Canada (combined population of 17,982), that aimed to deprescribe inappropriate medications through team-based medication reviews and a series of online workshops.

Objectives: To evaluate a) the impact of team-based medication reviews on decreasing the number of chronic medications; b) the impact of online workshops on statin and proton pump inhibitor (PPI) prescribing patterns.

Methods: A controlled before-after design was used to measure a) the odds of discontinuing chronic medications in small communities with pharmacist-physician medication reviews compared with the odds in two matched control groups that received either a standard medication review or no medication review; b) the odds of PPI and statin discontinuations in communities where clinicians participated in online workshops, compared with matched control communities without workshops. Adjusted odds ratios (aOR) were estimated by logistic regression models fit with generalized estimated equations. Meta-analysis with weighted odds ratios were used to pool impacts across the three communities for each of the two online workshops on drug discontinuations.

Results: Following a medication review, the percentage of patients who had discontinued at least one medication was highest in the intervention group (52%), followed by 45% in the standard medication review controls, and 36% in the no-review controls. Patients in the intervention group were 20% more likely to have at least one medication deprescribed than individuals in the medication review control group (aOR: 1.20; 95% CI: 1.03-1.39), whereas they were 42% more likely to deprescribe at least one medication compared to non-medication review controls (aOR: 1.42; 95% CI: 1.25-1.61). PPI discontinuations were not impacted by the educational webinar (aOR: 1.06; 95% CI: 0.76 - 1.48), whereas a slight non-significant impact on statin discontinuations was observed (aOR: 1.23; 95% CI: 0.64 - 2.36).

Conclusions: Team-based medication reviews were associated with a reduction in chronic medications, whereas online educational workshops did not significantly impact drug prescribing.