title: Reduction of polypharmacy by feedback to clinicians.
abstract: OBJECTIVE
  To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center.
  
  
  METHODS
  292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider (n = 102); intensive notification, provision of pharmacy profiles, compliance index, and chart review by senior clinician with recommendations (n = 104).
  
  
  METHODS
  Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center.
  
  
  METHODS
  All patients receiving greater than ten (10) active medications who are followed by clinic staff at the Denver VAMC. The mean age was 62 years (range 26-88) and 96% were male.
  
  
  METHODS
  The simple notification group received only a single letter recommending that the patient's number of medications be reduced. The intensive notification group received more sophisticated intervention with a chart review, two letters with calculation of patient compliance, and individualized suggestions for reduction in polypharmacy. The control group received no intervention.
  
  
  RESULTS
  Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months (p = 0.028). There was no significant difference between the intervention groups (p = 0.189). By six months the difference was no longer significant.
  
  
  CONCLUSIONS
  A simple intervention can result in a significant reduction in the number of medications prescribed to patients with polypharmacy. The authors were unable to show that a more complex intervention resulted in a further reduction in polypharmacy.
authors.affiliation: Department of Medicine, Denver VA Medical Center, Colorado 80220.
authors.forename: T J
authors.initials: TJ
authors.lastname: Meyer
authors.forename: D
authors.initials: D
authors.lastname: Van Kooten
authors.forename: S
authors.initials: S
authors.lastname: Marsh
authors.forename: A V
authors.initials: AV
authors.lastname: Prochazka
mesh_terms: D003120:Colorado; D004358:Drug Therapy; D004363:Drug Utilization; D005246:Feedback; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family