Electronic Health Reporter

By Josh Canavan, Head of Pharmacy, RazorMetrics.

Medication review is a routine part of long-term care. So, why isn’t deprescription more common? The reality is that turning standard reviews into meaningful change is difficult. Complicated medication regimens typically don’t change until there is problem—a safety issue, a non-adherence problem, cascading side effect prescriptions, or an adverse reaction.

Residents often arrive with multiple chronic conditions, a long list of accumulated prescriptions, and treatment plans shaped by different providers spread across various networks. As those layers build, long-term care facilities are faced with a new polypharmacy patient, with concurrent use of five or more medications, with a very real need to review the overall treatment plan for safety and sustainability in practice.

To be clear, polypharmacy is not an automatic sign of poor care. Residents may need a multi-drug prescribing approach to manage cardiovascular disease, diabetes, pain, depression, sleep issues, or cognitive decline and another set to address side effects of the medications. Trouble starts when prescription lists expand without enough review, coordination, or follow-up. At that point, prescriptions intended to support residents can instead put their health at risk.

Older adults are particularly vulnerable to the medication burden effect. Age-related changes in metabolism, kidney function, and body composition alter how the body metabolizes drugs. Frailty, dementia, and swallowing difficulties can add more complications. Layer several therapies together, and the risk of interactions, duplication, and adverse drug events rises quickly.

Complexity Builds Faster in Resident Care Settings

Pharmacists and prescribers know what to look for. They are trained to spot therapeutic duplication, unnecessary layering, medication cascades, and therapies that may raise the risk of confusion, side effects, fall risk, or poor adherence. The problem is that awareness alone doesn’t reduce the day-to-day burden of treatment.

A 2024 cross-sectional study in BMC Geriatrics of 67,531 older adults using facility-based care services found an average of seven prescriptions per patient, with polypharmacy and potentially inappropriate drug treatments frequently observed across the study population. Those findings show how quickly medication burden can become a safety issue and a day-to-day management challenge.

For caregivers, that creates a practical problem. A treatment plan may be clinically sound on paper, yet still fail if it becomes too costly, complex, or difficult to maintain. When that happens, the effects can manifest as missed doses, avoidable complications, greater staff involvement, and added strain on residents and families. Identifying those issues is only the first step. The more important challenge is converting that insight into completed, provider-approved changes.

Addressing Prescription Drug Cost Earlier Improves Follow-Through

A 2024 study in the American Journal of Health-System Pharmacy found that lower-cost alternatives accounted for 67.2% of real-time prescription benefit alerts, and prescribers selected those alternatives 32% of the time. When an alternative was chosen, prescription fill rates rose 15%, and patients saved an average of $27.77 per month on copay costs.

Affordability becomes much easier to manage when the prescribers are involved and can avoid shifting the burden to patients. For long-term care organizations, that has clear implications. Stronger support models help pharmacists and prescribers identify lower-cost options, reduce unnecessary duplication, and complete provider-approved changes earlier in the process.

The most effective support gives physicians a clearer path to act on optimization opportunities while preserving their clinical judgment. Technology that surfaces lower-cost alternatives, supports medication switching, offers deprescribing opportunities, and flags duplications helps physicians close the loop on standard medication review to meaningful change. And more importantly, the support works best when it fits within their usual clinic workflows.

Where Better Medication Management Begins

Safer medication management depends on turning reviews into timely, provider-approved changes. When care teams have better support to evaluate clinically appropriate alternatives early and act before complexity builds, they’re in a stronger position to reduce burden, support adherence, and protect residents from avoidable harm. In long-term care, medication review is only the starting point. What matters is whether this review leads to change.