End User Adaptation Experiences, Implementation Strategies, and Lessons Learned With the VIONE Medication Optimization and Safe Deprescribing Project in the Federal Health System

Purpose: There is extensive evidence linking Potentially Inappropriate Medication (PIM) use and adverse health outcomes. The VIONE core team and VA multidisciplinary partners created, implemented and disseminated the VIONE methodology across VA sites nationwide to facilitate and track deprescribing, through coaching, medical informatics and integration with the electronic health record. The purpose of this article is to report 3 sites in the federal health system (2 VA and 1 Indian Health Services) unique experiences of implementing and adapting VIONE locally while maintaining fidelity to fundamental VIONE intervention strategies. Methods: Three VA sites reported experiences of implementing VIONE, including an overview of the clinical workflow, clinicians involved, facilitators and barriers of implementation, and results. Results: The VIONE intervention was adapted for site-specific implementation. Personnel included trainees, clinical pharmacists, and home based primary care programs. Local and national dashboards were used to identify Veterans at high risk for polypharmacy and to track deprescribing. Implementation remained consistent with the VIONE core characteristics and facilitated education and conversations about medications with patients and caregivers. Adaptations were made at each site to meet that site’s needs. Implementation resulted in safe deprescribing practices and staff empowerment with significant cost savings. Conclusion: The VIONE methodology and tools are adaptable across clinical settings with inherent flexibility to local workflows and practice preferences by end users. VIONE presents a standardized, easy-to-use method for promoting medication review for older adults. Further evaluation may help identify best practices to promote positive outcomes related to deprescribing and reducing polypharmacy in older adults.