Johns Hopkins University School of Medicine
ALIGN: Aligning Medications with What Matters Most
Health Care Systems
Johns Hopkins University School of Medicine
Kaiser Permanente Institute for Health Research
Dr. Green is an assistant professor of medicine in the Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine. Her research focuses on improving communication between older adults, care partners and health care professionals about unnecessary and potentially harmful interventions, including medication use. As a member of the American Geriatrics Society (AGS) Clinical Practice Committee, Dr. Green co-wrote the Society’s recommendations for Choosing Wisely, a national initiative that promotes patient-physician conversations about unnecessary medical tests and procedures. Dr. Green received the AGS Choosing Wisely Champion Award for leading efforts to reduce overuse in medicine. Her research, supported by the NIA, is evaluating the impact on patient and care partner outcomes of pragmatic interventions to optimize prescribing for older adults with dementia in primary care. A former award-winning health journalist, Dr. Green has published personal essays and op-eds in Annals of Internal Medicine, The Washington Post and The New York Times, among other publications.
RATIONALE: Few deprescribing studies have targeted care partners of people living with dementia (PLWD), despite the enormous strain they face due to medication-related tasks. ALIGN builds on existing pharmacist-led comprehensive medication management programs by incorporating explicit focus on deprescribing to reduce medication regimen complexity and burden for care partners.
OBJECTIVE: To refine and pilot a workflow in which an embedded clinical pharmacist makes deprescribing recommendations to the primary care provider (PCP) to reduce medication regimen complexity for PLWD and their care partners.
SETTING: Primary care practices in two health care systems in Maryland and Colorado.
POPULATION: People living with dementia and multiple medications and their care partners.
DESIGN: The intervention will be embedded into the clinical flow of the primary care practices and delivered by clinical pharmacists who are already integrated throughout both health care systems. The intervention consists of: 1) direct-to-consumer deprescribing educational materials designed to activate the care partner and PLWD; 2) a telehealth visit in which a clinical pharmacist discusses benefits and harms of the patient’s medications with the patient and care partner in the context of their goals and preferences; and 3) pharmacist-PCP communication in which the pharmacist provides tailored deprescribing recommendations designed to be useful and actionable for the PCP.
OUTCOMES: The pilot study will establish the feasibility and acceptability of ALIGN in two health care systems, and will determine the feasibility of measuring two primary clinical outcomes: 1) the patient-level Medication Regimen Complexity Index and 2) the Family Caregiver Medication Administration Hassles Scale.
IMPACT: Findings from this pilot study will guide the design, implementation, and subsequent evaluation of ALIGN in a multicenter embedded pragmatic trial, laying the groundwork to optimize prescribing and improve outcomes for people living with dementia and their caregivers in a variety of primary care settings.