Enhancing Population Health with Integration of a Geriatric Pharmacy Specialist

Deprescribing and aligning medications with patient's health goals

As patients age and health conditions compound, multidisciplinary care is critical to high-quality care. At Cleveland Clinic’s Center for Geriatric Medicine, this includes the addition of a clinical pharmacy specialist.

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“We see having a geriatric pharmacist as part of a successful population health program,” says Ardeshir Hashmi, MD, Director of Cleveland Clinic’s Center for Geriatric Medicine. “It is also part of the national movement to deprescribe unnecessary medications that can cause more harmful side effects as patients age.” He notes that patients over 80 go through 52 physiological changes that cause their bodies to metabolize medications differently.

“Deprescribing can be an effective solution to the problem of polypharmacy,” explains Clinical Pharmacy Specialist Gina Ayers, PharmD, BCPS, BCGP, who joined the Center staff in fall 2018. “Our patients are especially vulnerable to an increased risk for adverse drug events, medication nonadherence, and functional decline, all of which lead to more hospital admissions and ED visits and increased healthcare costs.”

What this means in practice

Dr. Ayers provides direct patient care in the outpatient geriatric clinic and does rounding with the inpatient orthopaedic team on older adult patients. In 2019, Dr. Ayers will also be part of the Center’s new Successful Aging program, a comprehensive annual checkup inviting patients 50 and over to discuss healthcare goals and to be proactive in identifying cognitive and functional issues before they lead to full-blown dementia and frailty.

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Dr. Ayers is also working to develop and communicate internal medication guidelines for the Center’s staff, incorporating the most useful and up-to-date evidence, as well as clinical tools such as the Beers Criteria and anticholinergic cognitive burden (ACB) scale.

“In my role, I have the privilege of collaborating with healthcare teams to optimize medication regimens,” says Dr. Ayers. “Our goal is to improve quality of life for older adults and better align medications to patient care goals, preferences and values.”

Dr. Hashmi likens the Center’s multidisciplinary team approach, including pharmacy, to the PACE (Program of All-Inclusive Care for the Elderly) care model. With its “all services under one roof” approach, PACE has proven effective at better management of medications for the elderly, resulting in healthcare cost savings, shorter lengths of stay and decreased readmissions to the hospital.