Reducing polypharmacy among seniors

The administration of many drugs together to elderly patients is a well-known problem in geriatrics. In an effort to find a solution, Dr. Jacques Allard and colleagues set up a randomized controlled trial to evaluate the impact of an intervention program that targeted physicians with the aim of reducing the number of potentially inappropriate prescriptions (PIPs) given to elderly patients.

The trial involved 266 community-dwelling elderly people in Sherbrooke, Que. Of the 127 patients in the experimental group, 80 were subjects of an intervention consisting of a case conference to review their medication and a follow-up letter to their physician, with suggested changes in prescribing and evidence-based documentation. For the others in the experimental group, either the subject or the physician declined to participate, or eligibility had changed between initial recruitment and evaluation. The authors report that the mean number of PIPs declined by 0.24 in the experimental group (by 0.31 for those whose prescriptions were reviewed) and by 0.15 in the control group.

"Finally, the fact that an improvement in the drug profile was noticed in only 25% of the subjects in the experimental group with case conferences is a result undoubtedly influenced by the lack of consensus on certain questions related to drug use," conclude the authors. "Therefore, it is probable that some of our recommendations were not followed because physicians disagreed with them."

Efficacy of a clinical medication review on the number of potentially inappropriate prescriptions prescribed for community-dwelling elderly people
� J. Allard, R�jean H�bert, Maryse Rioux, Johanne Asselin, Louis Voyer