REDUCTION OF POLYPHARMACY BY FEEDBACK TO CLINICIAN

被引:64
作者
MEYER, TJ
VANKOOTEN, D
MARSH, S
PROCHAZKA, AV
机构
[1] Denver VAMC, Denver, 80220, CO
关键词
POLYPHARMACY; DRUGS; MEDICATIONS; UTILIZATION; INTERVENTIONS; PHYSICIAN BEHAVIOR;
D O I
10.1007/BF02598309
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective: To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center. Design: 292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider (n = 102); intensive notification, provision of pharmacy profiles, compliance index, and chart review by senior clinician with recommendations (n = 104). Setting: Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center. Patients/Participants: All patients receiving greater than ten (10) active medications who are followed by clinic staff at the Denver VAMC. The mean age was 62 years (range 26-88) and 96% were male. Interventions: The simple notification group received only a single letter recommending that the patient's number of medications be reduced. The intensive notification group received more sophisticated intervention with a chart review, two letters with calculation of patient compliance, and individualized suggestions for reduction in polypharmacy. The control group received no intervention. Measurements and main results: Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months (p = 0.028). There was no significant difference between the intervention groups (p = 0.189). By six months the difference was no longer significant. Conclusions: A simple intervention can result in a significant reduction in the number of medications prescribed to patients with polypharmacy. The authors were unable to show that a more complex intervention resulted in a further reduction in polypharmacy.
引用
收藏
页码:133 / 136
页数:4
相关论文
共 10 条
  • [1] Kroenke K., Polypharmacy: causes, consequences, and cure, Am J Med, 79, pp. 149-52, (1985)
  • [2] Oboler S.K., Blieden M.A., Carter S.A., Et al., A mobile internal medicine clinic, Arch Intern Med, 143, pp. 97-9, (1983)
  • [3] Kramer, Leventhal J.M., Hutchinson T.A., Feinstein A.R., An algorithm for the operational assessment of adverse drug reactions: I. Background, description and instructions for use, JAMA, 242, pp. 623-32, (1979)
  • [4] Steiner J.F., Koepsell T.D., Fihn S.D., Inui T.S., A general method of compliance assessment using centralized pharmacy records: description and validation, Med Care, 26, pp. 814-23, (1988)
  • [5] Steele M.A., Bess D.T., Franse V.L., Graber S.E., Cost effectiveness of two interactions for reducing outpatient prescribing costs, DICP Ann Pharmacother, 23, pp. 497-500, (1989)
  • [6] Martin A.R., Wolf M.A., Thibodeau L.A., Et al., A trial of two strategies to modify the test ordering behavior of medical residents, N Engl J Med, 303, pp. 1330-6, (1980)
  • [7] Cummins R.O., LoGerfo J.P., Inui T.S., Weiss N.S., High yield referral criteria for post traumatic skull roentgenography, JAMA, 244, pp. 673-6, (1980)
  • [8] Klein L.E., German P.S., Levine D.M., Et al., Medication problems among outpatients, Arch Intern Med, 144, pp. 1185-8, (1984)
  • [9] Smith J.W., Seidl L.G., Cluff L.E., Studies on the epidemiology of adverse drug reactions. V. Clinical factors influencing susceptibility, Ann Intern Med, 65, pp. 629-40, (1966)
  • [10] Karch F.E., Lasagna L., Adverse drug reaction — a critical review, JAMA, 231, pp. 1236-41, (1975)