Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults

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Abstract

High rates of inappropriate prescribing persist among older adults in many outpatient settings, increasing the risk of adverse drug events and drug-related hospitalizations.

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Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis

Kristen Anderson, Danielle Stowasser, Christopher Freeman … (2014)

Objective To synthesise qualitative studies that explore prescribers’ perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. Design A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. Setting All healthcare settings. Participants Medical and non-medical prescribers of medicines to adults. Outcomes Prescribers’ perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. Results 21 studies were included; most explored primary care physicians’ perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. Conclusions A multitude of highly interdependent factors shape prescribers’ behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the risk of iatrogenic harm.

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The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community.

D. Saliba, M. Elliott, L Rubenstein … (2001)

To develop a simple method for identifying community-dwelling vulnerable older people, defined as persons age 65 and older at increased risk of death or functional decline. To assess whether self-reported diagnoses and conditions add predictive ability to a function-based survey. Analysis of longitudinal survey data. A nationally representative community-based survey. Six thousand two hundred five Medicare beneficiaries age 65 and older. Bivariate and multivariate analyses of the Medicare Current Beneficiary Survey; development and comparison of scoring systems that use age, function, and self-reported diagnoses to predict future death and functional decline. A multivariate model using function, self-rated health, and age to predict death or functional decline was only slightly improved when self-reported diagnoses and conditions were included as predictors and was significantly better than a model using age plus self-reported diagnoses alone. These analyses provide the basis for a 13-item function-based scoring system that considers age, self-rated health, limitation in physical function, and functional disabilities. A score of >or=3 targeted 32% of this nationally representative sample as vulnerable. This targeted group had 4.2 times the risk of death or functional decline over a 2-year period compared with those with scores <3. The receiver operating characteristics curve had an area of.78. An alternative scoring system that included self-reported diagnoses did not substantially improve predictive ability when compared with a function-based scoring system. A function-based targeting system effectively and efficiently identifies older people at risk of functional decline and death. Self-reported diagnoses and conditions, when added to the system, do not enhance predictive ability. The function-based targeting system relies on self-report and is easily transported across care settings.

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Power and sample size calculations

William Dupont, Walton D. Plummer (1990)

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Author and article information

Journal

Title: JAMA

Abbreviated Title: JAMA

Publisher: American Medical Association (AMA)

ISSN (Print): 0098-7484

Publication date Created: November 13 2018

Publication date (Print): November 13 2018

Volume: 320

Issue: 18

Page: 1889

Affiliations

[1 ]Faculty of Pharmacy, Université de Montréal, Quebec, Canada

[2 ]Department of Medicine, McGill University, Montreal, Quebec, Canada

[3 ]Department of Epidemiology, McGill University, Montreal, Quebec, Canada

[4 ]Department of Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada

[5 ]Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada

[6 ]Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada

[7 ]Faculty of Medicine, Université de Montréal, Quebec, Canada

Article

DOI: 10.1001/jama.2018.16131

PMC ID: 6248132

PubMed ID: 30422193

SO-VID: f5271cb4-4e3b-42f0-a2bb-cc8f74df0b4b

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Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults : The D-PRESCRIBE Randomized Clinical Trial

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