February 10, 2025
Since May 2021, the Post-Acute and Long-Term Care Medical Association (PALTmed) and the American Society of Consultant Pharmacists (ASCP) have been holding meetings and developing resources as part of the Drive to Deprescribe (D2D) initiative to help prescribers, pharmacists, DONs, CNOs, CMOs, and CEOs optimize medication use in the long-term care setting, thereby reducing polypharmacy and enhancing patient care.
According to Jennifer Pruskowski, PharmD, MS, BCPS, BCGP, CPE, D2D was originally created to reduce the number of medications prescribed to nursing home residents by 25% and to build a network of professionals who would implement deprescribing into their practice. But as she explains, “It really has become a lot more than that. We would really call this a movement now. Initiatives are hard to sustain, and D2D is really here to stay.”
The main reason for that, she says, is ”because deprescribing is hard in the PALTC setting, and yet this is the population that needs it the most. PALTC residents take the most medications but, even more importantly, are at the highest risk of drug-induced mortality and morbidity. In D2D we focus on developing the ‘spidey senses’ that you need to tackle deprescribing-eligible medications before the patient does suffer an adverse drug event.”
The latest element in the D2D movement is a course, Design Your Deprescribing Intervention, launched last year. The just-introduced second module, Deprescribing Communication Techniques, offers a framework and practical strategies to foster trust, promote shared decision-making, and address common concerns around changing or stopping medications. It builds on the foundational concepts introduced in Module 1, Design Your Deprescribing Intervention.
Module 2's areas of focus include barriers to deprescribing, residents’ potential perceptions when discussing changes to drugs, how willing residents and family caregivers are to deprescribe, and the FRAME deprescribing communication map (Form or Fortify Relationship, Recognize Willingness to Deprescribe, Align Recommendations to Goals, Manage Cognitive Dissonance, and Empower to Continue Deprescribing).
As Dr. Pruskowski, the course director, explains, “Talking about deprescribing is all about how you ‘FRAME’ your discussion. Start with what matters to the resident and make sure you align all recommendations to that.”
She is quick to point out that it isn’t necessary to complete Module 1 before starting Module 2. “The goal is for these modules to stand alone, and for our D2D members to personalize their education when and how they want it,” she notes.
To that end, Dr. Pruskowski says the group “will next be tackling the evidence-based literature around deprescribing medications and medication classes such as antipsychotics, benzodiazepines, and antidiabetic medications.” She hopes this third module will be available in the next couple of months.
Dr. Pruskowski adds that she and the others involved with the course are open to suggestions for future modules. “This movement would be nowhere without the feedback of all of the D2D members, so please keep that feedback coming,” she explains. “Tell us what you need and we are happy to develop it for you!”
Click here for more information about the new course. You can find information about the D2D initiative–and get access to previous resources—on the same webpage.
