Elderly/Long-term Care

A pharmacy alert system plus physician-pharmacist collaboration can reduce inappropriate drug prescribing among elderly outpatients

A computerized pharmacy alert system plus collaboration between pharmacists and physicians can reduce inappropriate medication prescribing among elderly outpatients, concludes a new study. The computerized alert system linked drug prescription and age information to alert pharmacists when a patient aged 65 and older was newly prescribed 1 of 11 medications that are potentially inappropriate for older people.

Potentially dangerous medications include flurazepam, amitriptyline, ketorolac, and meperidine. The targeted medications can cause problems such as excessively low blood pressure, daytime sedation, high blood sugar levels, and serious gastrointestinal problems.

A research team randomized all 59,680 health plan members aged 65 years and older to the intervention or usual care group. Pharmacists received alerts on all intervention patients, who were newly prescribed a targeted medication. When they received an alert, pharmacists were required to answer specific questions in the pharmacy system before being able to print a label to dispense the prescription. In some cases, the intervention guided them to safer alternative medications, depending on the indication for the drug.

Pharmacists could also consult with the physician, who might recommended dispensing the drug as written or modified, dispensing an alternative medication, or stopping the medication altogether. Over the 1-year study period, 1.8 percent of the intervention group were newly dispensed at least one targeted medication compared with 2.2 percent of those in the usual care group.

This slight reduction in dispensed potentially dangerous drugs among the intervention group was primarily due to fewer dispensings of diazepam and amitriptyline. The modest difference in dispensing of potentially dangerous drugs between groups highlights the challenges of modifying prescriber behavior.

The study was supported by the Agency for Healthcare Research and Quality (HS14249).

See "Randomized trial to improve prescribing safety in ambulatory elderly patients," by Marsha A. Raebel, Pharm.D., Jeanya Charles, Pharm.D., Jennifer Dugan, Pharm.D., and others, in the July 2007 Journal of the American Geriatric Society 55, pp. 977-985.

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