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J Am Med Dir Assoc. 2011 Jun;12(5):326-30. doi: 10.1016/j.jamda.2010.08.013. Epub 2010 Oct 20.

Physician intervention for medication reduction in a nursing home: the polypharmacy outcomes project.

Author information

1
The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96817, USA. bktamura@hotmail.com

Abstract

OBJECTIVE:

To examine the effects of a medication review project by geriatricians and geriatric medicine fellows on polypharmacy in a teaching nursing home.

DESIGN:

Quality improvement intervention study

SETTING:

Long-term care facility in Honolulu, HI PARTICIPANTS: Seventy-four patients with the Minimum Data Set quality indicator criteria of polypharmacy (9 or more medications).

INTERVENTION:

Geriatric medicine fellows and faculty reviewed each patient's medication list, consulted the updated Beers Criteria and Epocrates online drug-drug interaction program, and recommended medication changes to the patients' primary care physicians.

MEASUREMENTS:

Descriptive statistics, including means, standard deviations, and sums of variables were obtained for the number of medications in the following categories: total number, scheduled, pro re nata, high risk, contraindicated, with potential drug-drug interactions, and with no indication.

RESULTS:

Of 160 patients residing in a nursing home, 74 were on 9 or more medications. After the intervention, the mean number of medications per patient in the following categories decreased significantly: total number (16.64 to 15.54, P < .001), scheduled (11.3 to 10.99, P < .001), pro re nata (5.33 to 4.56, P < .001), high risk (0.94 to 0.73, P < .001), contraindicated (0.29 to 0.13, P = .004), with potential drug-drug interactions (6.1 to 4.83, P < .001), and with no indication (3.34 to 3.29, P = .045).

CONCLUSION:

Polypharmacy in long-term care is prevalent and can lead to increased adverse effects and potentially inappropriate prescriptions. This study demonstrates an effective geriatrician-led intervention that both reduced polypharmacy and provided core competency training for geriatric medicine fellows.

PMID:
21450207
PMCID:
PMC3102122
DOI:
10.1016/j.jamda.2010.08.013
[Indexed for MEDLINE]
Free PMC Article

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