Spokane Journal of Business

Minimizing inappropriate medications

Researchers find success changing doctor behavior, reducing potential errors

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Researchers at Philadelphia-based Thomas Jefferson University's Jefferson School of Population Health, working with colleagues at the Parma Local Health Authority in Italy, say they significantly reduced the prescribing of dangerous medications for older people during a three-year, proof-of-concept study. The study was so successful, researchers contend, that enrollees adopted its practices permanently.

The rate of potentially inappropriate medications (PIMs) dropped by 9.8 percent, attributable to the study. PIMs were reduced by 31 percent in Parma and 22 percent in a control community. Investigators believe that a third of that reduction (10 percent) was caused directly by the study interventions. A report on the study appears in a recent issue of the journalDrugs and Aging.

The study's implications are dramatic for the U.S. and other developed nations, researchers say. In the U.S., 30 percent of all medications are prescribed for people over the age of 65, they say. An Institute of Medicine study identified $21 billion in annual U.S. health care spending caused by medication errors. Outpatient preventable medication errors cost $4.2 billion per year.

Rather than focus on educating patients, researchers sought to change the behavior of physicians, each of whom treats hundreds of patients.

"The public doesn't realize how many elderly patients are exposed every day to potentially dangerous medications that can severely affect their health," says Vittorio Maio, an author of the study at the Jefferson School. "Changing physician behavior is very difficult, but we showed it can be done."

Jefferson and Parma researchers were able to reduce the prescribing of dangerous medications by 9.8 percent. This decrease in prescribing what's known as the Beers List of PIMS could translate into hundreds of millions of dollars saved annually.

"Elderly people are using so many medications that the choice of safe ones is an issue of paramount importance. Older people often ask their doctors for additional drugs for pain relief, but some of these drugs can be toxic for frail patients," says Dr. Del Canale, of Parma.

The study engaged all 303 general practitioners in the Local Health Authority in Parma, Italy, who together treat tens of thousands of patients over age 65. Investigators first distributed the list of PIMs to the general practitioners, established a baseline level at which they were being prescribed, then conducted educational sessions with the general practitioners. Later, they tested the incidence with which general practitioners were still prescribing the PIMs. They also studied a similar community nearby as a control group. After these interventions, prescribing of PIMs in Parma had dropped by 10 percent.

"Prescribing potentially dangerous medications to older adults is a serious, but preventable problem worldwide. Our efforts in Parma, Italy, to change prescribing behaviors spared over 600 people exposure to these drugs in the fall of 2009 alone," says the Jefferson School's Dr. Scott Keith.

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