U.S. Deprescribing Research Network: Assessment of Medication Optimization in Rural Kentucky Appalachian patients with mild cognitive impairment or dementia: The AMOR Kentucky Study

Medication-related problems are often the cause of emergency room visits, hospitalizations, and transition to higher levels of care in older adults experiencing cognitive impairment. Medication complexity adds to the caregiver burden and often results in negative health outcomes and diminished quality of life for both, the patient and the caregiver. Nowhere is this problem more real and impactful than in the underserved, lower socioeconomic, and health disparity populations in rural Appalachian Kentucky. Outreach into such areas to improve healthcare through interventions such as multidisciplinary deprescribing and medication optimization has been further impacted by the current COVID-19 pandemic. Developing novel, remotely delivered, deprescribing and medication optimization strategies to such populations is a primary goal of our efforts. Utilizing our vast and well-established (16 years of operation) rural telemedicine clinic focused on aging in cognitive decline, we propose to develop and assess the efficacy of remote strategies for medication optimization and healthcare assessment. We will evaluate remote delivery of optimal deprescribing strategies that will serve as a translational bridge between our prior work at the University of Kentucky and service delivery to underserved populations. Such efforts will serve as a model to be further investigated in other health disparate and underserved populations nationwide. These efforts are bolstered by our previous experience implementing deprescribing regimens in a tertiary care setting, our adaptation to remote medication therapy management during the time of COVID, our well-established network of engaged rural healthcare practices, as well as our ability to deliver such interventions directly into the homes of those living remotely and underserved, health disparate, regions of rural Kentucky Appalachia. Mobilizing our resources to optimize an immediately implementable strategy for remote outreach using HIPAAcompliant videoconferencing technology, allows for both an immediate direct impact on such interventions in the time of COVID, and will greatly expand the translational reach to health disparity populations that may be geographically distanced from the core centers of the parent grant. Our well-established experience in providing medication therapy management interventions to the aging population with and without cognitive decline has allowed us to develop routine practices of assessment of medication appropriateness using the medication appropriateness index and clinical guidelines such as the Beers criteria, as well as implementation of a multidisciplinary physician-pharmacist team targeting improvement in cognitive outcomes in the aging population. This approach will be carried forward through a telemedicine practice that is comprised of approximately 500 patient-caregiver dyads throughout rural areas of Appalachian Kentucky.