title: Physician intervention for medication reduction in a nursing home: the polypharmacy outcomes project.
abstract: OBJECTIVE
  To examine the effects of a medication review project by geriatricians and geriatric medicine fellows on polypharmacy in a teaching nursing home.
  
  
  METHODS
  Quality improvement intervention study
  
  
  METHODS
  Long-term care facility in Honolulu, HI PARTICIPANTS: Seventy-four patients with the Minimum Data Set quality indicator criteria of polypharmacy (9 or more medications).
  
  
  METHODS
  Geriatric medicine fellows and faculty reviewed each patient's medication list, consulted the updated Beers Criteria and Epocrates online drug-drug interaction program, and recommended medication changes to the patients' primary care physicians.
  
  
  METHODS
  Descriptive statistics, including means, standard deviations, and sums of variables were obtained for the number of medications in the following categories: total number, scheduled, pro re nata, high risk, contraindicated, with potential drug-drug interactions, and with no indication.
  
  
  RESULTS
  Of 160 patients residing in a nursing home, 74 were on 9 or more medications. After the intervention, the mean number of medications per patient in the following categories decreased significantly: total number (16.64 to 15.54, P < .001), scheduled (11.3 to 10.99, P < .001), pro re nata (5.33 to 4.56, P < .001), high risk (0.94 to 0.73, P < .001), contraindicated (0.29 to 0.13, P = .004), with potential drug-drug interactions (6.1 to 4.83, P < .001), and with no indication (3.34 to 3.29, P = .045).
  
  
  CONCLUSIONS
  Polypharmacy in long-term care is prevalent and can lead to increased adverse effects and potentially inappropriate prescriptions. This study demonstrates an effective geriatrician-led intervention that both reduced polypharmacy and provided core competency training for geriatric medicine fellows.
authors: The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96817, USA. bktamura@hotmail.com
authors: Bruce K
authors: BK
authors: Tamura
authors: Christina L
authors: CL
authors: Bell
authors: Karen
authors: K
authors: Lubimir
authors: Wendy N
authors: WN
authors: Iwasaki
authors: Laura A
authors: LA
authors: Ziegler
authors: Kamal H
authors: KH
authors: Masaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005851:Geriatric Nursing; D006254:Hawaii; D006801:Humans; D008297:Male; D008485:Medical Audit; D009735:Nursing Homes; D010819:Physician's Role; D019338:Polypharmacy; D011785:Quality Assurance, Health Care