Tatyana Gurvich, PharmD, BCGP, APh will lead a pilot program to provide pharmacist-led medication reviews for members of vulnerable communities that are disproportionally burdened by Alzheimer’s and dementia.
The goal is to screen for high-risk medications that can contribute to cognitive slippage, and review medication lists for polypharmacy and irrational prescribing, with the goal of early detection, prevention and intervention.
Starting in fall 2024, the medication-review program is sponsored by California Advancing and Innovating Medi-Cal (CalAIM) Enhanced Care Management (ECM) program through a partnership with Alzheimer’s Los Angeles.
Gurvich, a board-certified geriatric pharmacist, is an associate professor of clinical pharmacy (clinician-educator) at USC Mann and adjunct assistant professor in family medicine at UC Irvine Medical Center. She has served for more than a decade as a geriatric clinical pharmacologist/clinical preceptor at the UCI Health SeniorHealth Center, a collaborative geriatric primary care practice, where she sees patients in clinic, provides telemedicine services to patients in the community, and makes pharmacotherapy recommendations to attending physicians, medical residents and geriatric fellows.
Additionally, she supervises fourth-year USC pharmacy students and USC pharmacy practice residents, and lectures and precepts third-year medical students during their primary care rotation.
Pharmacists can identify causes of reversible cognitive ‘slippage’
Gurvich notes that accurate—and early—diagnosis is extremely important. As patients age, the prevalence of polypharmacy—use of five or more medications—increases along with the rate of adverse events related to inappropriate prescribing.
“Our goal is to identify patients whose cognitive decline is at least in part attributable to medications which can be discontinued, substituted or adjusted, resulting in improved or resolved cognition,” says Gurvich, who was appointed to the Board of Pharmacy Specialties (BPS) Geriatric Pharmacy Specialty Council for the 2025-27 term. “One of the reversible causes of cognitive slippage are high-risk medications such as those with an anticholinergic profile as well as some sedative hypnotic meds. Pharmacists should be working together with prescribers to deprescribe those meds so that a more accurate diagnosis is made.”
“A careful medication review by a geriatric clinical pharmacist can be helpful to eliminate high-risk medications, which contribute to cognitive decline as well as those medications and supplements which increase the risk of bleeding and other adverse events.”
USC Mann pharmacy students and residents will participate in the medication reviews.
CalAIM is an initiative of the California Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Medi-Cal members. A key feature is an Enhanced Care Management benefit and a menu of community supports, which can substitute for covered MediCal services as cost-effective alternative services.