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Reducing polypharmacy in the elderly. A controlled trial of physician feedback
1Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814.
Journal of the American Geriatrics Society
|January 1, 1990
Summary
Reducing polypharmacy in older adults through physician feedback showed modest success. Interventions decreased medication number, complexity, and cost, but physician compliance varied, highlighting patient and prescribing barriers.
Area of Science:
- Geriatrics
- Clinical Pharmacy
- Health Services Research
Background:
- Polypharmacy, the use of multiple medications, is prevalent in elderly patients.
- A significant proportion of elderly patients (33%) were found to be taking five or more prescription drugs.
Purpose of the Study:
- To evaluate the effectiveness of a prospective, controlled trial aimed at reducing polypharmacy in patients aged 65 and older.
- To assess physician compliance with recommendations for medication discontinuation or regimen simplification.
Main Methods:
- A prospective, controlled trial was conducted in a teaching hospital's residents' clinic.
- Recommendations for medication changes were provided to physicians for patients with polypharmacy.
- Outcomes were compared between patients whose physicians received recommendations and a control group.
Main Results:
- Patients whose physicians were informed of recommendations showed a significant reduction in the mean number of drugs, complexity, and cost of their regimens compared to controls.
- Physician compliance was highest for dosage schedule simplification (100%) and lowest for medication discontinuation (40%).
- Noncompliance was often due to patient refusal or medications prescribed by other physicians.
Conclusions:
- Feedback to primary physicians can offer benefits in reducing polypharmacy.
- Substantial reductions in outpatient polypharmacy may necessitate addressing patient-related barriers and limiting the number of prescribing physicians.