Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. This randomized controlled trial tested the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. The study was set at Kaiser Permanente Northern California, an integrated health system with multiple pre-existing deprescribing workflows. Eligible patients were aged ≥76 years using ≥10 prescription medications. The intervention included physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. A priori primary effectiveness endpoints included change in the number of medications and in the prevalence of geriatric syndrome from 181-365 days after allocation. Second endpoints included utilization and adverse drug withdrawal effects. Information was obtained from the electronic health record.

Inclusion Criteria:

• Kaiser Permanente patients

• Age ≥76 years

• ≥10 drugs (excluding topicals) where

  • drug filled ≥2 times in the past year and
  • drug last filled < 180 days ago

Exclusion Criteria:

• less than 12 months preceding enrollment at Kaiser Permanente
• no primary care practitioner assigned
• on dialysis
• history of heart, liver, lung, breast, or bone marrow transplant
• in hospice
• under active treatment for cancer during the past 12 months
• has received an intervention through the Pharmacy Targeted Deprescribing Program in the preceding year.