Improving prescribing in the elderly: a study in the long term care setting

Area of Science:

• Geriatric Medicine
• Pharmacology
• Healthcare Quality Improvement

Background:

• Potentially inappropriate prescribing (PIP) is a significant concern in long-term care (LTC) settings, impacting patient safety and healthcare costs.
• Identifying predictors of PIP is crucial for developing targeted interventions.
• The effectiveness of pharmacist-led interventions in improving prescribing patterns for elderly patients needs further investigation.

Purpose of the Study:

• To determine the prevalence and predictors of potentially inappropriate prescribing (PIP) in LTC patients aged 65 and over.
• To evaluate the effectiveness of follow-up pharmacist letters in improving prescribing practices.
• To identify common types of PIP and associated patient factors.

Main Methods:

• Utilized the Improving Prescribing in the Elderly Tool on charts of 355 LTC patients (≥65 years).
• Consensus panel verified PIP; follow-up letters with safer alternatives were sent to physicians.
• Reviewed patient charts two months post-intervention for prescription changes.

Main Results:

• 18.3% of patients (65/355) had PIP, with anticholinergic drugs, tricyclic antidepressants, and long-acting benzodiazepines being most common.
• Higher medication counts, mental illness history, and high depression MDS scores predicted PIP.
• PIP was less common in patients seen by geriatric specialists; 37.9% of PIPs were changed after pharmacist letters.

Conclusions:

• Potentially inappropriate prescribing is prevalent in long-term care settings.
• Follow-up pharmacist letters are an effective strategy to improve prescribing for elderly patients.
• Targeted interventions addressing common PIP types can enhance medication safety in LTC.