Rural long-term care (LTC) is a challenge for medical directors at a number of levels, including coordinating regulation with practice, systems development and process, and staff mind set. The process of deprescribing is a critical element of today’s nursing home practice. Primary care providers are judged by their success in reducing dangerous medications as much as they are in adding on medications for new clinical syndromes. There are significant morbidity and mortality issues associated with medication prescribing in LTC populations. This is manifested by falls and fractures, weight loss, and delirium as well as readmissions to emergency rooms and hospitals with mortality. In order to demonstrate deprescribing patterns, medications in various categories will be quantitated on admission, day 30 and day 90. Medication classes will include cardiovascular, dementia, anticoagulatants, PPI/H2 blockers, opioids, benzodiazepines, muscle relaxants, sleeping medications, and antipsychotics. We will compare urban vs. rural deprescribing patterns up to 90 days after admission in Colorado and Wyoming. These patterns of deprescrbing are going to be scrutinized by the Centers for Medicare & Medicaid Services and the the Centers for Disease Control and Prevention as the practice of LTC medicine is becoming more of a focus for these governmental regulatory agencies.
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