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

摘要

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.