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A multifactorial intervention to lower potentially inappropriate medication use in older adults in Argentina

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Abstract

Background

Adverse drug reactions are a common cause of potentially avoidable harm, particularly in older adults.

Aims

To evaluate the feasibility and efficacy of a pilot multifactorial intervention to reduce potentially inappropriate medication (PIM) use in older adults.

Methods

We conducted a phase 2, feasibility, open-label study in the ambulatory setting of an integrated healthcare network in Buenos Aires, Argentina. We recruited primary care physicians (PCPs) and measured PIM use in a sample of their patients (65 years or older). Educational workshops for PCPs were organized with the involvement of clinician champions. Practical deprescribing algorithms were designed based on Beers criteria. Automatic email alerts based on specific PIMs recorded in each patient’s electronic health record were used as a reminder tool. PCPs were responsible for deprescribing decisions. We randomly sampled 879 patients taking PIMs from eight of the most commonly used drug classes at our institution and compared basal (6 months prior to the intervention) and final (12 months after) prevalence of PIM use using a test of proportions.

Results

There was a significant reduction (p < 0.05) in all drug classes evaluated. Non-Steroidal Anti-Inflammatory Drugs (basal prevalence 5.92%; final 1.59%); benzodiazepines (10.13%; 6.94%); histamine antagonists (7.74%; 3.07%); opioids (2.16%; 1.25%); tricyclic antidepressants (8.08%; 4.10%); muscle relaxants (7.74%; 3.41%), anti-hypertensives (3.53%; 1.82%) and oxybutynin (2.96%; 1.82%). The absolute reduction in the overall prevalence was 8.5 percentage points (relative reduction of 51.4%).

Conclusion

This multifactorial intervention is feasible and effective in reducing the use of potentially inappropriate medication in all drug classes evaluated.

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Acknowledgements

Prof. Montero-Odasso’s program in Gait and Brain Health is supported by grants from the Canadian Institutes of Health Research (CIHR; MOP 211220, PJT 153100), the Ontario Ministry of Research and Innovation (ER11–08–101), the Ontario Neurodegenerative Diseases Research Initiative (OBI 34739), and Department of Medicine Program of Experimental Medicine Research Award (POEM 768915), University of Western Ontario. He is the first recipient of the Schulich Clinician-Scientist Award. Abdelhady Osman is the recipient of Ontario Graduate Scholarship (OGS) award for the year 2020–2021.

Funding

No funds were received for this study.

Author information

Authors and Affiliations

  1. Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina

    Marcelo Schapira, Pablo Calabró, María Elena Guajardo, Bernardo Martínez, Javier Pollán, Luis Cámera, Miguel Sassano & Gastón Perman

  2. Geriatric Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada

    Manuel Montero-Odasso

  3. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada

    Manuel Montero-Odasso & Abdelhady Osman

  4. Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada

    Manuel Montero-Odasso & Abdelhady Osman

  5. Department of Public Health, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina

    Javier Pollán & Gastón Perman

Authors
  1. Marcelo Schapira
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  2. Pablo Calabró
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  3. Manuel Montero-Odasso
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  4. Abdelhady Osman
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  5. María Elena Guajardo
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  6. Bernardo Martínez
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  7. Javier Pollán
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  8. Luis Cámera
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  9. Miguel Sassano
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  10. Gastón Perman
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Contributions

MS, PC, MMO, MEG, BM, JP, LC, MSa and GP contributed to the study conception and design. Workshops were prepared and delivered by MS, MEG and MSa. Data collection and preliminary analysis was performed by MEG, BM and GP. Further analyses and interpretation of results were done by GP, MS, MMO and AO. The first draft of the manuscript was written by GP and all authors commented on previous versions of the manuscript. AO and MMO edited and proofread the revised version of the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Gastón Perman.

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Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board (Comité de Ética de Protocolos de Investigación) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Verbal informed consent was obtained from medical doctors who participated in the study. Patients gave written consent for their data to be used for research.

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Schapira, M., Calabró, P., Montero-Odasso, M. et al. A multifactorial intervention to lower potentially inappropriate medication use in older adults in Argentina. Aging Clin Exp Res 33, 3313–3320 (2021). https://doi.org/10.1007/s40520-020-01582-4

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  • DOI: https://doi.org/10.1007/s40520-020-01582-4

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