Patient Safety/Quality

Algorithms can enhance communication between pharmacists and physicians about medications prescribed for elderly patients

Up to 13 percent of medications prescribed for residents of 30 North Carolina nursing homes were potentially inappropriate, that is, could lead to serious health problems, found a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00011). However, an algorithm suggesting safer alternatives to inappropriate medications was well received by consultant pharmacists at the nursing homes studied.

Jennifer B. Christian, Pharm.D., M.P.H., of Brown University's Center for Gerontology and Health Care Research, and her colleagues estimated the prevalence of potentially inappropriate medications used in the nursing homes. The researchers then developed 14 treatment algorithms—each based on extensive research review and discussions with pharmacists—which suggest appropriate alternatives to inappropriate medications. Pharmacists in the long-term care pharmacy serving the nursing homes were required to respond to online inappropriate medication alerts by recommending directly to the prescribing physician a safer alternative medication based on the treatment algorithms.

Online alerts ranged from long-acting benzodiazepines, which can cause severe health problems in the elderly, to antihistamines and muscle relaxants, which can cause less severe problems. Alerts also included drug-diagnosis combinations, that is, alerts for drugs that can cause problems for individuals diagnosed with certain conditions. Examples include tricyclic antidepressants prescribed for individuals with cardiac arrhythmia or corticosteroids prescribed for people with diabetes.

For each potentially inappropriate medication, the algorithm provided information regarding when the medication might be used appropriately in the elderly population and the rationale for why and under what circumstances the medication is deemed as potentially inappropriate. Suggestions for possible treatment alternatives were also provided.

See "Alternatives for potentially inappropriate medications in the elderly population: Treatment algorithms for use in the Fleetwood Phase III study," by Dr. Christian, Anne vanHaaren, Pharm.D., Kathleen A. Cameron, R.Ph., M.P.H., and Kate L. Lapane, Ph.D., in the November 2004 Consultant Pharmacist 19(11), pp. 1011-1028.

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