Reduction of polypharmacy by feedback to clinicians

To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center.

292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider (n = 102); intensive notification, provision of pharmacy profiles, compliance index, and chart review by senior clinician with recommendations (n = 104).

Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center.

All patients receiving greater than ten (10) active medications who are followed by clinic staff at the Denver VAMC. The mean age was 62 years (range 26-88) and 96% were male.

The simple notification group received only a single letter recommending that the patient's number of medications be reduced. The intensive notification group received more sophisticated intervention with a chart review, two letters with calculation of patient compliance, and individualized suggestions for reduction in polypharmacy. The control group received no intervention.

Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months (p = 0.028). There was no significant difference between the intervention groups (p = 0.189). By six months the difference was no longer significant.

A simple intervention can result in a significant reduction in the number of medications prescribed to patients with polypharmacy. The authors were unable to show that a more complex intervention resulted in a further reduction in polypharmacy.