Physician Intervention for Medication Reduction in a Nursing Home: The Polypharmacy Outcomes Project

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• 作者：Bruce K. Tamura ; Christina L. Bell ; Karen Lubimir ; Wendy N. Iwasaki ; Laura A. Ziegler ; Kamal H. Masaki
• 关键词：Polypharmacy ; long-term care ; nursing home
• 刊名：Journal of the American Medical Directors Association
• 出版年：2011
• 出版时间：June 2011
• 年：2011
• 卷：12
• 期：5
• 页码：326-330
• 全文大小：83 K

文摘

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.