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Effects of a Drug Minimization Guide on Prescribing Intentions in Elderly Persons with Polypharmacy

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Abstract

Background

While frameworks exist to assist clinicians in prescribing appropriately in older patients at risk of adverse drug reactions, their impact on prescribing is uncertain.

Objective

The aim of the study was to determine the effects of a ten-step drug minimization guide on clinician prescribing intentions involving a hypothetical older patient receiving multiple drugs.

Methods

A total of 61 hospital clinicians were presented with clinical information about a hypothetical case: an 81-year-old female with 12 chronic diseases, receiving 19 different medications. On a standardized, anonymous form, each participant indicated, as a pre-test, which drugs they felt strongly inclined to discontinue or continue, and which drugs they were uncertain about. The ten-step guide was then presented and applied to the case, and participants repeated the drug selection process.

Results

Sixty evaluable forms were analysed from 19 consultant physicians, 17 medical registrars, 7 interns/residents and 17 pharmacists. Among the entire cohort, the mean (±SD) number of drugs selected for discontinuation increased from 6.0 (±2.7) pre-test to 9.6 (±3.2) post-test (p < 0.001), with the greatest increases seen among consultant physicians (6.6 [±2.3] to 11.5 [±2.9], p < 0.001) and clinical pharmacists (5.3 [±2.6] to 8.9 [±2.2], p <0.001). The number of drugs associated with uncertainty decreased from 3.7 (±2.9) pretest to 1.8 (±2.3) post-test (p < 0.001) for the whole cohort, with the greatest decreases seen among consultant physicians (4.8 [±2.6] to 1.8 [±2.5], p < 0.001) and clinical pharmacists (4.5 [±3.3] to 1.9 [±2.0], p = 0.003).

Conclusion

This self-report study involving a hypothetical case provides evidence that a drug minimization guide may reduce inappropriate prescribing and uncertainty around drug indications.

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Acknowledgements

No funding was received to conduct this study or prepare this article. The authors declare that they have no conflicts of interest.

Apart from the authors, no other persons made any substantial contributions to the work.

Guarantor: IAS, as the principal investigator, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland, QLD 4102, Australia

    Ian A. Scott MBBS, FRACP, MHA, MEd

  2. Centre for Academic Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australia

    Leonard C. Gray

  3. Southern School of Medicine, University of Queensland, Brisbane, Queensland, Australia

    Jennifer H. Martin

  4. Centre for Safe and Effective Prescribing, University of Queensland, Brisbane, Queensland, Australia

    Charles A. Mitchell

Authors
  1. Ian A. Scott MBBS, FRACP, MHA, MEd
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  2. Leonard C. Gray
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  3. Jennifer H. Martin
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  4. Charles A. Mitchell
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Corresponding author

Correspondence to Ian A. Scott MBBS, FRACP, MHA, MEd.

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Scott, I.A., Gray, L.C., Martin, J.H. et al. Effects of a Drug Minimization Guide on Prescribing Intentions in Elderly Persons with Polypharmacy. Drugs Aging 29, 659–667 (2012). https://doi.org/10.1007/BF03262281

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  • DOI: https://doi.org/10.1007/BF03262281

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