Reduction of Potentially Inappropriate Medication in the Elderly

Area of Science:

• Geriatric Medicine
• Pharmacology
• Clinical Pharmacy

Background:

• Potentially inappropriate medications (PIM) are drugs with unfavorable risk-benefit profiles in the elderly, often having safer alternatives.
• The PRISCUS list, developed in 2010 for the German market, identifies such medications.
• The RIME trial investigated interventions to reduce PIM and drug-drug interactions (DDI) in elderly primary care patients.

Purpose of the Study:

• To evaluate the effectiveness of special training and a PRISCUS card in reducing PIM and DDI among elderly patients.
• To compare the impact of physician-only training versus entire practice team training on PIM/DDI rates.

Main Methods:

• A three-armed, cluster-randomized controlled trial involving 137 primary care practices in Germany.
• Practices were assigned to physician training, team training, or a control group with general instructions.
• The primary endpoint was the percentage of patients with at least one PIM or DDI at one year.

Main Results:

• At baseline, 39.8% of 1138 elderly patients taking multiple medications had at least one PIM/DDI.
• After one year, PIM/DDI rates were 41.3% in intervention groups and 37.6% in the control group.
• The estimated intervention effect was not statistically significant (p=0.36 for any intervention vs. control; p=0.22 for team vs. physician training).

Conclusions:

• The interventions tested in the RIME trial did not significantly reduce the percentage of elderly patients experiencing potentially inappropriate medications or drug-drug interactions.
• Further strategies may be needed to effectively decrease PIM and DDI in this population.