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) pre-test 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.
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) pre-test 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.
Authors: Joseph T Hanlon; Carl F Pieper; Emily R Hajjar; Richard J Sloane; Catherine I Lindblad; Christine M Ruby; Kenneth E Schmader Journal: J Gerontol A Biol Sci Med Sci Date: 2006-05 Impact factor: 6.053
Authors: Arun N Bhatt; Sherin S Paul; Smitha Krishnamoorthy; Basil T Baby; Anna Mathew; Balakrishnan R Nair Journal: J Family Community Med Date: 2019 Sep-Dec