title: Polypharmacy management among Australian veterans: improving prescribing through the Australian Department of Veterans' Affairs' prescriber feedback programme.
abstract: BACKGROUND
  Older patients are potentially at risk from the effects of polypharmacy (PP) and/or drug-drug interactions.
  
  
  OBJECTIVE
  To examine the effects of a targeted patient-specific prescriber feedback programme on patients prescribed more than 19 individual medications over the 3-month study period.
  
  
  METHODS
  The Commonwealth Department of Veterans' Affairs commissioned a review of Repatriation Pharmaceutical Benefit Scheme claims data to identify patients potentially at risk of drug injury through either PP (> or =20 unique medications during 3 months) or clinically significant drug interactions (DI). Dispensing information for the patient at risk, relevant clinical guidelines and a personalized covering letter were mailed to the main prescribing general practitioner of the identified veteran patient. The claims data were then re-analysed after the programme.
  
  
  RESULTS
  There was a significant reduction in the mean number of unique medications prescribed over a 3-month period 1 year after the prescriber feedback (mean change = -2.22; 95% confidence interval -3.54 to -0.90; P = 0.0013) for patients identified with ongoing PP. There was also a significant reduction in the number of DI pairs (mean change = -0.73; 95% confidence interval -0.77 to -0.69; P < 0.0001) for the patients identified with an ongoing DI. The number of patients dispensed one or more DI pairs decreased from 836 to 318 after the feedback.
  
  
  CONCLUSIONS
  A targeted prescriber feedback programme can influence general practitioner prescribing at an individual patient level and, therefore, contribute to the quality use of medicines.
authors.affiliation: Aged and Residential Care, Heidelberg Repatriation Hospital, Melbourne, Victoria, Australia. michael.woodward@austin.org.au
authors.forename: M C
authors.initials: MC
authors.lastname: Woodward
authors.forename: C L
authors.initials: CL
authors.lastname: Streeton
authors.forename: A
authors.initials: A
authors.lastname: Guttmann
authors.forename: G T
authors.initials: GT
authors.lastname: Killer
authors.forename: R W
authors.initials: RW
authors.lastname: Peck
mesh_terms: D000368:Aged; D001315:Australia; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D019338:Polypharmacy; D011785:Quality Assurance, Health Care; D014728:Veterans