Efficacy of a clinical medication review on the number of potentially inappropriate prescriptions prescribed for community-dwelling elderly people.
BACKGROUND
The administration of many drugs concurrently to elderly patients is a well-known problem in geriatrics and involves numerous risks. One way to reduce polypharmacy is to provide information to physicians in order to modify their prescribing practices. The main objective of this study was to evaluate the impact of an intervention program that targeted physicians with the aim of reducing the number of potentially inappropriate prescriptions (PIPs) given to elderly patients.


METHODS
A randomized controlled trial was carried out among community-dwelling elderly people in Sherbrooke, Que. The participants were 266 patients over 75 years of age (experimental group: n = 136, control group: n = 130). A team comprising 2 physicians, a pharmacist and a nurse reviewed the list of drugs and the diagnoses of a subgroup of the experimental group in a case conference. Suggestions were formulated and mailed to the patients' physicians together with relevant scientific documentation justifying the recommendations. The main outcome measure was the number of PIPs.


RESULTS
The mean number of PIPs per patient declined by 0.24 in the experimental group (n = 127) and by 0.15 in the control group (n = 116). The decline in PIPs was even larger in the experimental group that had case conferences (n = 80), in which the mean number of PIPs per patient declined by 0.31. However, this difference between the experimental group and the control group was not statistically significant in the intent-to-treat analysis. The number of drugs prescribed was not modified by the intervention, nor were the results of the global assessment of the patients' drug profiles.


CONCLUSIONS
This study suggests that the intervention program had no effect on the prescribing of PIPs.
Allard
J
J
Department of Family Medicine, Faculty of Medicine, University of Sherbrooke, Que. jallard@courrier.usherb.ca
Hébert
R
R
Rioux
M
M
Asselin
J
J
Voyer
L
L
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review / Q000458:organization & administration*; D004502:Education, Medical, Continuing / Q000458:organization & administration; D005260:Female; D015577:Geriatric Assessment; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011792:Quebec; D011795:Surveys and Questionnaires