Helping Veterans stop unnecessary medications

Dr. Sara Swathy Battar frequently observed patients transferred from acute to long-term caretaking upwards of 15-20 medications. She also discovered some Veterans often do not adhere to prescribed medication schedules due to side effects, confusion, and cost.

To improve patient safety, comfort, and medication compliance, Dr. Battar developed a methodology to help Veterans and staff identify and reduce, taper or discontinue unnecessary, ineffective, and inappropriate medications.

Many Veterans take multiple medications, especially in the later stages of life. Frequently these medications were prescribed long ago and can cause undesirable side effects, including reduced functional capacity.

This simultaneous use of multiple pharmaceuticals (known as polypharmacy) can lead to dangerous drug interactions. In many care settings, no standardized approach exists to holistically examine a patient’s complete medication profile, identify potentially inappropriate medications and determine which medications are compatible, safe, necessary and indicated.

Multiple medications increase risks

Battar is determined to make sure Veterans receive the best care, starting with reviewing the medications they take. Patients taking multiple medications can have increased risks of experiencing harmful drug effects such as allergic reactions, medication errors, and accidental overdose. Her innovative approach helps to ensure Veterans are only taking the correct medications with the right doses.

Battar teamed up with Academic Detailing Pharmacist Dr. Kimberly Dickerson and Chief of Pharmacy Tim Cmelik to create an electronic tracking system embedded into clinical profiles to capture data on deprescribed medications.

The program is called VIONE which stands for:

Vital – is this medication essential for my health?

Important – How important is this medication to improve my quality of life?

Optional – By taking this medicine, do the benefits outweigh the risks?

Not Indicated – Am I taking medications that are no longer needed?

Every medication has a reason -Does every medication I take have a clear reason or diagnosis?

Battar describes one impressive outcome: “One of our Veterans on the dementia unit had been non-conversant, non-interactive and non-ambulatory for years. Through the VIONE approach, the pharmacist and clinicians worked together and deprescribed several of his medications over 6 months. He eventually woke up singing, walking, lucid, and joyful. It was like seeing a miracle unfold in front of my eyes.”

Air Force Veteran Barry Mitchell Vuletich tells Dr. Battar, “The lesser medicines I have to take, the better off I am.”

Impact: Over 8400 Veterans have benefitted

Deprescribing medications using this approach has resulted in decreased pill burden and improved utilization of human and economic resources. At Central Arkansas VA Medical Center, between February 2016 and September 2018, over 8,400 Veterans have benefited from the program with almost 15,000 prescriptions deprescribed.

Eight other VA facilities have implemented VIONE. More than 18,000 medications have been discontinued in over 10,000 Veterans and the VIONE tool was exported to 31 VA medical centers.

VIONE has improved patient safety and increased patient quality of life.

As one Veteran put it: “Every provider I went to see just added more and more medicines but I felt only worse with each additional pill. Then you guys came along and started stopping medications one by one and I felt stronger, my sleep was improved, my mental sharpness returned and I feel so much healthier overall.”

Dr. Sara Swathy Battar, a board-certified physician in Geriatrics, Hospice, and Palliative Care Medicine is the Associate Chief of Staff, Geriatrics and Extended Care Service at the Central Arkansas Veterans Health Care System.