title: Methods to control the pharmaceutical cost impact of chronic conditions in the elderly.
abstract: Multimorbidity is the main cause of polypharmacy in elderly people, with the consequent increment in cost and use of inappropriate medication. To control cost, specific strategies have been implemented in healthcare services to reduce potentially inappropriate prescription. Many interventions are applied online during the prescription process using computerized decision support systems, for example, therapeutic algorithms and alerts. Other interventions can be categorized as offline due to their application before or after the prescription process, the main strategies being financial incentives, medication reviews and organizational change. All these strategies are complementary and multifaceted. There is evidence that some of these interventions are effective, but further research should be directed in this field, including investigation of patient cost and outcomes.
authors.affiliation: Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio7J, Campus de Vera s/n 46022-Valencia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Vivas-Consuelo
authors.forename: Ruth
authors.initials: R
authors.lastname: Usó-Talamantes
authors.forename: José Luis
authors.initials: JL
authors.lastname: Trillo-Mata
authors.forename: Pablo
authors.initials: P
authors.lastname: Mendez-Valera
mesh_terms: D000368:Aged; D000465:Algorithms; D002908:Chronic Disease; D020000:Decision Support Systems, Clinical; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics* / Q000517:prevention & control; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards*
keywords: computerized support systems; cost control; inappropriate prescribing; medication-related problems; multimorbidity; older people; polypharmacy; risk adjustment