| Physician Intervention for Medication Reduction in a Nursing Home: The Polypharmacy Outcomes Project. | |
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MedLine Citation:
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PMID: 21450207 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: To examine the effects of a medication review project by geriatricians and geriatric medicine fellows on polypharmacy in a teaching nursing home. DESIGN: Quality improvement intervention study SETTING: Long-term care facility in Honolulu, HI PARTICIPANTS: Seventy-four patients with the Minimum Data Set quality indicator criteria of polypharmacy (9 or more medications). INTERVENTION: Geriatric medicine fellows and faculty reviewed each patient's medication list, consulted the updated Beers Criteria and Epocrates online drug-drug interaction program, and recommended medication changes to the patients' primary care physicians. MEASUREMENTS: Descriptive statistics, including means, standard deviations, and sums of variables were obtained for the number of medications in the following categories: total number, scheduled, pro re nata, high risk, contraindicated, with potential drug-drug interactions, and with no indication. RESULTS: Of 160 patients residing in a nursing home, 74 were on 9 or more medications. After the intervention, the mean number of medications per patient in the following categories decreased significantly: total number (16.64 to 15.54, P < .001), scheduled (11.3 to 10.99, P < .001), pro re nata (5.33 to 4.56, P < .001), high risk (0.94 to 0.73, P < .001), contraindicated (0.29 to 0.13, P = .004), with potential drug-drug interactions (6.1 to 4.83, P < .001), and with no indication (3.34 to 3.29, P = .045). CONCLUSION: Polypharmacy in long-term care is prevalent and can lead to increased adverse effects and potentially inappropriate prescriptions. This study demonstrates an effective geriatrician-led intervention that both reduced polypharmacy and provided core competency training for geriatric medicine fellows. |
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Authors:
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Bruce K Tamura; Christina L Bell; Karen Lubimir; Wendy N Iwasaki; Laura A Ziegler; Kamal H Masaki |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2010-10-20 |
Journal Detail:
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Title: Journal of the American Medical Directors Association Volume: - ISSN: 1538-9375 ISO Abbreviation: - Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2011-3-31 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100893243 Medline TA: J Am Med Dir Assoc Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI (B.K.T., C.L.B., K.L., L.A.Z., K.H.M.). |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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