The association between prescribing patterns and type of primary care visit among older adults with polypharmacy: a cross-sectional study

Background: Primary health care has been vitally disrupted by the COVID-19 crisis. Changes in primary care delivery in COVID-19 present an opportunity to study how patients and primary care professionals have adapted to the crisis. With the wide adoption of telehealth modalities, understanding changes in prescribing practices among elderly patients could serve to reduce adverse drug events. With the ongoing adoption of telehealth services, there are concerns about the potential of inappropriate prescribing practices. Moreover, older adults who take more medications and require more monitoring than all other age groups could be disproportionately impacted by policies enacted to limit the spread of SARS-Cov-2. The complex care requirements of elderly patients with multimorbidity's heightened health care strains due to COVID-19, and medication errors can have significant negative health consequences on elderly patients. In this cross-sectional study, we looked for associations between prescribing practices and visit modality for adults with polypharmacy within primary care. Methods: Through post-visit surveys, we interviewed a total of 64 low-acuity patients ≥ 50 who were on more than 5 medications and were attended by a provider within the Family Medicine Clinic at HSC Health Clinic between June 2021 and August 2021. Of the 64 patients, that were interviewed, 32 had an in-person visit and 32 had telehealth visits with their providers. The providers were also asked to complete a survey about their visit with the patient and the types of changes that were made during the consult. We looked for an association between the visit modality type and prescription changes through the following question: "Did the total number of medicines or supplements change as a result of this visit" from the surveys provided by the providers. Logistic regression was used to look at the association between prescription changes & visit modality while controlling for age and gender. Results: Of the 64 patients that completed the survey, age (M = 66.66 years, SD = 9.57 years), gender included Female (n=50) and Male (n=14). Data for this study included adults who self-reported as White (n=43), Black or African American (n=19), Prefer not to Answer (n=1) and Unknown or not Listed (n=1). The association between prescription changes and visit modality was found to be non-significant (odds ratio [OR] .1.140; 95% confidence interval [CI] .417-3.115). This finding did not change even while adjusting for gender and age (adjusted odds ratio [OR] .820; 95% confidence interval [CI] .384-3.35). Conclusions: Prescription changes were similar between in-person visits and telehealth visits for adults ≥ 50 years who were on ≥ 5 medications while adjusting for gender and age. If differences between visit modality and prescribing changes were to be found other factors should be investigated. Given the need to reduce medication errors among older adults, providers can provide accessibility options through different visit modalities while ensuring consistency in medication changes.