UR Nursing Scientist Receives Pilot Award to Simplify Medication Use Among Older Adults

Throughout her career as a nurse scientist, Jinjiao Wang, PhD, RN, assistant professor at University of Rochester School of Nursing, has sought to improve the quality and outcomes of post-acute care and home health care for older adults with complex medical conditions who take multiple medications.

In May, Wang received a one-year pilot award from the U.S. Deprescribing Research Network (USDeN), an NIH R24 research center dedicated to developing and disseminating evidence about deprescribing and improving medication use among older adults. She was the only nurse scientist selected to receive pilot funding this year from the USDeN.

In the home health care arena, a routine nursing visit requires the documentation of all the medications a patient takes. Usually, patients older than 65 experience a lot of chronic conditions such as diabetes, hypertension, heart disease, depression, and arthritis and take more than five medications (i.e., polypharmacy). Each medication could have a list of side effects that require more medications to offset these side effects.

“There’s often a lot of crossover when an older person takes on average 10 medications for five or more chronic conditions,” said Wang. “But if we can achieve better or equivalent treatment outcomes with five meds, why take 10?” 

One cause of over-prescribing and polypharmacy is a lack of communication among the multiple health care providers of the patient. Home health care nurses conduct comprehensive medication reviews during home visits, but they don’t have the authority to change prescriptions. The patient’s Primary Care Provider (PCP) can deprescribe but rarely has access to the complete home-based medication review data that home health nurses have. Additionally, clinical pharmacists — professionals who are trained to review medications and suggest deprescribing targets — mostly work in the hospital and are often not accessible in the community. Rarely, do the parties interact, let alone communicate what each other is prescribing to the patient, leading to medication duplicates, errors, and unncessary use of certain medications.

“That kind of conversation is rarely initiated, also because the word “deprescribing” may be associated with abandoning of care,” said Wang. “We’re trying to break the stigma associated with deprescribing. In fact, most patients would agree to stop taking certain, potentially inappropriate or unnecessary, medications if their PCP recommends it. The goal of this study is to empower each party with complete information and help the multiple parties collaborate efficiently about medication issues, so as to help the patient successfully transition back to the community after hospital discharge.”

Wang’s study aims to simplify and optimize the patient’s medication regime with a more unified interdisciplinary care team and through the use of telehealth, which will help reduce the cost of medications and burden of symptoms.

Starting this fall, home health care patients in the Rochester area will be selected for their age and the number of medications they’re taking and invited to participate in the study. In each home visit, Wang’s team will conduct comprehensive medication review, collect complete medication data, have it reviewed by the clinical pharmacist, and then convene with the patient’s PCP via telehealth to discuss any opportunities to simplify the medications. The patient will also provide feedback on their experience.

Wang hopes the promising results of the study can be used across other home health care organizations and in future efforts to deprescribe, which is a relatively new research sphere.

“I think part of the reason I received this funding is that I'm in a unique field. In nursing, we learn to care for patients in a holistic way and that is the very foundation of deprescribing,” said Wang. “I wouldn’t be in this position if it weren’t for the support of Dean Kathy Rideout, Sally Norton, Kathi Heffner, and Ying Xue at the School of Nursing. So, instead of being the only nurse scientist to receive this recognition, I’d like to think of us as the only school of nursing recognized by this institution. It really is a great honor.”