A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy.
OBJECTIVE
To evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians.


METHODS
Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (> or = 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A clinical pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance and knowledge, number of medications, patient satisfaction, and physician receptivity.


RESULTS
Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2%) versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the clinical pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P <0.001).


CONCLUSIONS
This study demonstrates that a clinical pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.
Hanlon
J T
JT
Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina 27710, USA.
Weinberger
M
M
Samsa
G P
GP
Schmader
K E
KE
Uttech
K M
KM
Lewis
I K
IK
Cowper
P A
PA
Landsman
P B
PB
Cohen
H J
HJ
Feussner
J R
JR
D000368:Aged; D000553:Ambulatory Care; D004347:Drug Interactions; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010601:Pharmacology, Clinical; D010820:Physicians; D011369:Professional-Patient Relations; D011788:Quality of Life