Peer prescription review had no effect on potentially inappropriate prescriptions for the elderly

Egan, Mary PhD, OT(C)

Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Faculty of Health Science, University of Ottawa, Canada

Abstracted from:Allard J, Hebert R, Rioux M, Asselin J, Voyer L. Efficacy of a clinical medication review on the number of potentially inappropriate prescriptions prescribed for community dwelling elderly people. Can Med Assoc J 2001; 164(9): 1291-1296 .

Evidence-based Healthcare 5(4):p 127, December 2001.

BACKGROUND

The health risks associated with potentially inappropriate prescriptions to elderly patients increase with the number of drugs concurrently administered. Education and feedback strategies between physicians and other experts can reduce risks but are difficult and expensive to implement.

OBJECTIVE

Evaluation of a physician targeted intervention to reduce the number of potentially inappropriate prescriptions to elderly patients.

SETTING

Quebec, Canada; timeframe not specified.

METHOD

Randomised controlled trial.

LITERATURE REVIEW

No explicit strategy; 20 references.

PARTICIPANTS

Eighty people older than 75 years living in the community using more than three drugs per day and at risk of losing their autonomy. Participants were recruited from the Quebec Health Insurance Board database (Régie de l'asurance-maladie du Québec).

INTERVENTION

Usual care or intervention. A committee of two physicians, a pharmacist and nurse reviewed the intervention group's drug use based on physician's diagnosis and provided recommendations to the physician.

OUTCOMES

Number of potentially inappropriate prescriptions (using Quebec Committee on Drug Use in the Elderly list); number of different drugs taken per day; number of patients with more than one potentially inappropriate prescription; change in medications pre- and post-intervention.

MAIN RESULTS

One-quarter of the committee's recommendations were implemented. Absolute 'potentially inappropriate' prescription rates decreased more in the intervention group (decline of 0.24 versus 0.15 for controls; P < 0.001). Intention-to-treat analysis, however, showed no significant difference between control and intervention groups.

AUTHORS' CONCLUSIONS

The invention programme had no significant influence on potentially inappropriate prescriptions.

NOTE

Limited improvement in the drug profile of intervention patients could be due to a lack of consensus on appropriate drug use, limited sample sizes and the sample population. Two different criteria were used to determine 'potentially inappropriate prescriptions.'