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Rate ePoster

Quality Improvement (Original Research)

Addressing Polypharmacy and Potentially Inappropriate Medication Use in Spinal Cord Injury Practice

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Original Research Theater

    Poster Presenter(s)

  • Sunil Sabharwal, MD

    SCI Chief and Fellowship Director
    VA Boston Healthcare Sys/ Harvard Medical School
    Boston, Massachusetts

    • Co-Author(s)

  • ER

    Elizabeth Roux, Other

    Medical Student
    Harvard Medical School
    Boston, Massachusetts

Disclosure(s):
Sunil Sabharwal, MD: No financial relationships to disclose
Background and/or Objectives: Medications prescribed for multiple conditions increase vulnerability of people with spinal cord injury (SCI) to polypharmacy risks.

Objectives: 1) Examine medication use in an SCI cohort. 2) Implement systematic interventions to reduce polypharmacy and potentially inappropriate medication (PIM) use. 3) Identify frequency and reasons for discontinuing medications following the intervention.

Design: Retrospective cohort study

Setting : Veterans Affairs (VA) SCI Center

Participants : 307 veterans with SCI

Interventions: We examined medication use for patients seen for SCI annual examinations over a 1-year period (Fiscal Year 2024), including number of medications, VIONE score, and anticholinergic burden (ACB). We initiated a systematic approach to deprescribing, consisting of identifying PIMs and potential deprescribing opportunities when medication risk was assessed to outweigh the benefit within the context of patient specific factors. The VIONE (Vital, Important, Optional, Not indicated, and Every medication has an indication) tool was used to identify medications that could potentially be deprescribed. When deprescribing was warranted, VIONE discontinuation reasons were selected in the electronic medical record. Data was electronically stored in a national dashboard.

Main Outcome Measures: Reasons for deprescribing potentially inappropriate medications such as duplication of medications, drug-drug interactions, and medications that were considered unnecessary for a specific patient.

Results: The average number of medications per person was 12.5. Only 19 individuals were on 5 or less medications, 48 had 6-10 medications, 170 had 11-20, while 70 had over 20 medications. The average VIONE score was 4.11 and ACB score was 2.6. Preliminary analysis of deprescribing information in the VIONE dashboard, over a 3-month intervention period, indicated that the top 3 deprescribing reasons were patient was not taking the prescribed medication (n = 43), alternate medication was prescribed (n=42), or the medication was not indicated (n=35).

Conclusions: Embedding deprescribing into standard workflow in an SCI practice can reduce PIMs and address polypharmacy.