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Effects of Medication Assessment as Part of a Comprehensive Geriatric Assessment on Drug Use over a 1-Year Period

A Population-Based Intervention Study

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Abstract

Background

High drug consumption among the elderly and inappropriate prescribing practices increase the risk of adverse drug effects in this population. This risk may be decreased by conducting, for example, a medication review alone or as part of a comprehensive geriatric assessment (CGA); however, little is known about the fate of the changes in medication made as a result of the CGA or medication review.

Objective

To study the performance of the CGA with regards to medication changes and to determine the persistence of these changes over a 1-year period.

Methods

This study was a population-based intervention study. A random sample of 1000 elderly (age ≥75 years) was randomized either to a CGA group or to a control group. Home-dwelling patients from these groups (n = 331 and n = 313 for intervention and control groups, respectively) were analysed in this study. Study nurses collected information on medication at study entry and 1 year later in both groups; in the intervention group, study physicians assessed, and changed when appropriate, the medication at study entry. The medication changes and their persistence over 1 year were then evaluated.

Results

Medication changes were more frequent in the intervention group than in the control group. Regular medication was changed during follow-up in 277 (83.7%) and in 228 (72.8%) [odds ratio (OR) 1.9; 95% CI 1.3, 2.8] patients in the intervention and control groups, respectively. In the intervention group, study physicians were responsible for 35.4% of all new prescriptions and for 15.6% of all drug terminations. Changes took place particularly in the prescription of CNS drugs. About 58% of the drugs initiated by study physicians were still in use 1 year later, and 25.5% of those terminated by study physicians had been reintroduced.

Conclusion

Drug intervention as part of a CGA can be used to rationalize the drug therapy of a patient. However, its effectiveness is subsequently partly counteracted by other physicians working in the healthcare system.

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References

  1. Barat I, Andreasen F, Damsgaard EM. The consumption of drugs by 75-year-old individuals living in their own homes. Eur J Clin Pharmacol 2000; 56: 501–9

    Article  PubMed  CAS  Google Scholar 

  2. Jyrkkä J, Vartiainen L, Hartikainen S, et al. Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study. Eur J Clin Pharmacol 2006; 62: 151–8

    Article  PubMed  Google Scholar 

  3. Nguyen JK, Fouts MM, Kotabe SE, et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006; 4: 36–41

    Article  PubMed  Google Scholar 

  4. Turnheim K. Drug therapy in the elderly. Exp Gerontol 2004; 39: 1731–8

    Article  PubMed  CAS  Google Scholar 

  5. Bregnhoj L, Thirstrup S, Kristensen MB, et al. Prevalence of inappropriate prescribing in primary care. Pharm World Sci 2007; 29: 109–15

    Article  PubMed  Google Scholar 

  6. Hanlon JT, Schmader KE, Ruby CM, et al. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 2001; 49: 200–9

    Article  PubMed  CAS  Google Scholar 

  7. Lechevallier-Michel N, Gautier-Bertrand M, Alperovitch A, et al. Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study. Eur J Clin Pharmacol 2005; 60: 813–9

    Article  PubMed  Google Scholar 

  8. Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006; 54: 1516–23

    Article  PubMed  Google Scholar 

  9. Stuck AE, Beers MH, Steiner A, et al. Inappropriate medication use in community-residing older persons. Arch Intern Med 1994; 154: 2195–200

    Article  PubMed  CAS  Google Scholar 

  10. Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci 2007; 62: 1172–81

    Article  PubMed  Google Scholar 

  11. Ahmed A, Allman RM, DeLong JF. Inappropriate use of digoxin in older hospitalized heart failure patients. J Gerontol A Biol Sci Med Sci 2002; 57: M138–43

    Article  PubMed  Google Scholar 

  12. Ahmed A, Allman RM, DeLong JF, et al. Age-related underutilization of angiotensin-converting enzyme inhibitors in older hospitalized heart failure patients. South Med J 2002; 95: 703–10

    PubMed  Google Scholar 

  13. Kelly J, Chamber J. Inappropriate use of loop diuretics in elderly patients. Age Ageing 2000; 29: 489–93

    Article  PubMed  CAS  Google Scholar 

  14. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003; 163: 2716–24

    Article  PubMed  Google Scholar 

  15. McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997; 156: 385–91

    PubMed  CAS  Google Scholar 

  16. Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 2007; 63: 725–31

    Article  PubMed  Google Scholar 

  17. Düsing R. Overcoming barriers to effective blood pressure control in patients with hypertension. Curr Med Res Opin 2006; 22: 1545–53

    Article  PubMed  Google Scholar 

  18. Cramer JA, Gold DT, Silverman SL, et al. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 2007; 18: 1023–31

    Article  PubMed  CAS  Google Scholar 

  19. Saltvedt I, Spigset O, Ruths S, et al. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study. Eur J Clin Pharmacol 2005; 61: 921–8

    Article  PubMed  Google Scholar 

  20. Frankfort SV, Tulner LR, van Campen JP, et al. Evaluation of pharmacotherapy in geriatric patients after performing complete geriatric assessment at a diagnostic day clinic. Clin Drug Investig 2006; 26: 169–74

    Article  PubMed  CAS  Google Scholar 

  21. Kuo HK, Scandrett KG, Dave J, et al. The influence of outpatient comprehensive geriatric assessment on survival: a meta-analysis. Arch Gerontol Geriatr 2004; 39: 245–54

    Article  PubMed  Google Scholar 

  22. Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005; 71: 45–59

    Article  PubMed  Google Scholar 

  23. Bula CJ, Berod AC, Stuck AE, et al. Effectiveness of preventive in-home geriatric assessment in well functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc 1999; 47: 389–95

    PubMed  CAS  Google Scholar 

  24. Davis RG, Hepfinger CA, Sauer KA, et al. Retrospective evaluation of medication appropriateness and clinical pharmacist drug therapy recommendations for home-based primary care veterans. Am J Geriatr Pharmacother 2007; 5: 40–7

    Article  PubMed  Google Scholar 

  25. Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc 2007; 55: 658–65

    Article  PubMed  Google Scholar 

  26. Zermansky AG, Alldred DP, Petty DR, et al. Clinical medication review by a pharmacist of elderly people living in care homes: randomised controlled trial. Age Ageing 2006; 35: 586–91

    Article  PubMed  Google Scholar 

  27. Lampela P, Hartikainen S, Sulkava R, et al. Adverse drug effects in elderly people: a disparity between clinical examination and adverse effects self-reported by the patient. Eur J Clin Pharmacol 2007; 63: 509–15

    Article  PubMed  Google Scholar 

  28. Rikala M, Hartikainen S, Sulkava R, et al. Validity of the Finnish Prescription Register for measuring psychotropic drug exposures among elderly Finns: a population-based intervention study. Drugs Aging 2010; 27(4): 337–49

    Article  PubMed  Google Scholar 

  29. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98

    Article  PubMed  CAS  Google Scholar 

  30. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  31. World Health Organization. Guidelines for ATC classification and DDD assignment. Oslo: WHO, Collaborating Centre for Drug Statistics Methodology, 1995

    Google Scholar 

  32. National Agency for Medicines. Classification of medicines (ATC) and defined daily doses (DDD) 2004. Helsinki: National Agency for Medicines, 2004

    Google Scholar 

  33. Hartikainen S, Rahkonen T, Kautiainen H, et al. Use of psychotropics among home-dwelling nondemented and demented elderly. Int J Geriatr Psychiatry 2003; 18: 1135–41

    Article  PubMed  Google Scholar 

  34. Linjakumpu T, Hartikainen S, Klaukka T, et al. Psychotropics among the home-dwelling elderly: increasing trends. Int J Geriatr Psychiatry 2002; 17: 874–83

    Article  PubMed  CAS  Google Scholar 

  35. Grossman H, Bergmann C, Parker S. Dementia: a brief review. Mt Sinai J Med 2006; 73: 985–92

    PubMed  Google Scholar 

  36. Bonnick SL. Osteoporosis in men and women. Clin Cornerstone 2006; 8: 28–39

    Article  PubMed  Google Scholar 

  37. Park S, Johnson MA. What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status? Nutr Rev 2006; 64: 373–8

    Article  PubMed  Google Scholar 

  38. Lokk J. News and views on folate and elderly persons. J Gerontol A Biol Sci Med Sci 2003; 58: 354–61

    Article  PubMed  Google Scholar 

  39. Boonen S, Vanderschueren D, Haentjens P, et al. Calcium and vitamin D in the prevention and treatment of osteoporosis: a clinical update. J Intern Med 2006; 259: 539–52

    Article  PubMed  CAS  Google Scholar 

  40. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71–86

    Article  Google Scholar 

  41. van der Linden MJ, Kersker MCH, Bijl AMH, et al. Represcription after adverse drug reaction in the elderly: a descriptive study. Arch Intern Med 2006; 166: 1666–7

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors have no conflicts of interest that are directly relevant to the content of this study. The GeMS study was financed by the Finnish Social Insurance Institution and the city of Kuopio, Finland. This study was supported by the Clinical Drug Research Graduate School.

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Authors and Affiliations

  1. Department of Pharmacology and Toxicology, University of Kuopio, P.O. Box FIN-1627, 70211, Kuopio, Finland

    Pasi Lampela

  2. Faculty of Pharmacy, University of Kuopio, Kuopio, Finland

    Sirpa Hartikainen

  3. Leppävirta Health Center, Leppävirta, Finland

    Sirpa Hartikainen

  4. Department of Geriatrics, School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland

    Piia Lavikainen & Raimo Sulkava

  5. Rheumatism Foundation Hospital, Heinola, Finland

    Raimo Sulkava

  6. Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland

    Risto Huupponen

  7. Clinical Pharmacology Unit, Tykslab, Turku University Hospital, Turku, Finland

    Risto Huupponen

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  1. Pasi Lampela
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  2. Sirpa Hartikainen
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  3. Piia Lavikainen
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  4. Raimo Sulkava
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  5. Risto Huupponen
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Correspondence to Pasi Lampela.

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Lampela, P., Hartikainen, S., Lavikainen, P. et al. Effects of Medication Assessment as Part of a Comprehensive Geriatric Assessment on Drug Use over a 1-Year Period. Drugs Aging 27, 507–521 (2010). https://doi.org/10.2165/11536650-000000000-00000

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  • DOI: https://doi.org/10.2165/11536650-000000000-00000

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