Table 2.
Pre- and postgraduate geriatric pharmacology education, sorted by health professional
| Study | Country | Health professional | Course description | Quantitative description | Type of teaching | In curriculum | Evaluation | Level of evaluation* | Strength of findings† | |
|---|---|---|---|---|---|---|---|---|---|---|
| Undergraduate | ||||||||||
| Estus et al. (2010) [52, 53] | USA | Pharm students (pharmD) | Geriatric pharmacotherapy | 120 h (3 CH) | Facebook, ‘adopt a patient’, patient cases, book and film clubs, lectures, scientific and reflective writing | Yes | Elective | Students' (n = 28) satisfaction on Facebook use: 93% valuable. Students' (n = 92) satisfaction on other teaching methods: 3.8–4.7 out of maximum 5 points | 1 | 1 |
| Jaedhe (2009) [54] | Germany | Pharm students | Individual pharmacotherapy, 1/6 topics geriatric patients | 5 h for 6 topics | Lectures | Yes | Both | ? | ||
| Divine & Cain (2009) [55] | USA | Pharm students | Polypharmacy adherence as part of geriatric course | Total course 120 h (3 CH) | Polypharmacy medication simulation project, reflective assignment | Yes | Elective | Qualitative research on students' satisfaction (n = 173, response rate 100%): 83% positive comments on education on open-ended questions | 1 | 1 |
| Ross et al. (2006) [56] | USA | Pharm students | Vertical integrated course. 68 topics of which Alzheimer's and Parkinson's disease | 80 h for 68 topics | Small groups | Yes | Mandatory | ? | ||
| Sauer (2006) [24] | USA | Pharm students | Pharmacy practice experience in ambulatory care, topic geriatrics | 6 weeks, half time | Rotations | Yes | Mandatory | Qualitative research using portfolio essays: 107 of 117 portfolios studied, essay pre-experience and postexperience. Students' attitudes towards elderly improved | 2a | 4 |
| Lam (2005) [57] | USA | Pharm students | Geriatric clerkship | 160 h | Clerkship | Yes | Elective | Students n = 24. 65% of written advices to prescribers was adopted by prescriber | 4b | 1 |
| Bratt (2003) [58] | UK | Pharm students | CNS pharmacology, 1 topic: Alzheimer's disease | 10 h | Integrated, hybrid lecture and PBL containing lectures, seminars and self study | Yes | Mandatory | Of 104 students, 51.4% preferred traditional lectures to the PBL; 54.2% PBL did aid knowledge retention. Mature students (44%) vs. younger students (25.8%) preferred PBL over traditional lectures (P < 0.01, Mann–Whitney U rank sum test) | 1 | 1 |
| Strohkirch & Jaehde (2003) [59] | Germany | Pharm students | clinical pharmacology. Topics: geriatrics, renal failure, medication review | ? | Lectures, workshops, bedside teaching, practice simulation | Yes | Elective | ? | ||
| George & Jacobs (2011) [60] | USA | Medical students, residents and fellows | Geriatric pharmacotherapy | 23 times, 1 h sessions | Seminars using the Medication Screening Questionnaire | Yes | ? | Qualitative evaluation of education. 163 of 241 participants. 99% (strongly) agreed that overall quality of the sessions was excellent. All (strongly) agreed on meeting learning goals | 1 | 1 |
| Naritoku & Faingold (2009) [61] | USA | Medical students | Pharmacotherapeutics, 1 topic, Alzheimer's disease | 1 h | (Interactive) lectures | Yes | Mandatory | n = 39, response rate 64%. Students' satisfaction on Alzheimer's topic: 4.7 ± 0.61 (out of 5) | 1 | 1 |
| Franson et al. (2008) [22] | Netherlands | Medical students | Pharmacology, 1 topic geriatrics | Average time 1–2 h | e-Learning | Yes | Mandatory | 1100 students, >175 000 hits. Time spent on the program was associated with grades on topic: regression equation grade = 5.02 + 0.034 × time spent on program | 2b | 3 |
| Dubois et al. (2007) [23] | Netherlands | Medical students | Geriatric pharmacotherapy | ? | Therapeutic plan writing and self-study computer materials | Yes | Both | Cohort 1999 vs. cohort 2000 with intervention: percentage of students with sufficient result on therapeutic plan writing in intervention cohort improved compared with pre-intervention cohort (31% vs 69% two-sample t-test, P < 0.05) | 2b | 4 |
| Smith et al. (2006) [62] | Australia | Medical students | Polypharmacy as part of rational prescribing course | 12 modules | e-Learning | Yes | ? | In total, 363 students on online survey (response rate 6–13% in different years): 91–92% content module appropriate, 78–86% felt equipped to prescribe | 1 | 1 |
| Eroglu & Uresin (2003) [63] | Turkey | Medical students | Pharmacology education, geriatrics 1 of 17 subjects | 24 h for all 17 subjects | PBL | Yes | Mandatory | ? | ||
| Herzig et al. (2003) [64]; Antepohl & Herzig (1999) [65] | Canada | Medical students | Pharmacology course, 1 topic Parkinson's disease | 3 h per topic | Problem based learning vs Lecture based learning | No | Pretest, post-test, post-test after 18 months showed no differences in the PBL group (n = 17/55, mean score on final test 20.1 ± 5.0) vs. the lecture-based learning group (n = 15/57, mean score on final test 19.0 ± 4.7) on pharmacology knowledge. 80 students were lost to follow-up for the final post-test | 2b | 1 | |
| Faingold & Dunaway (2002) [66] | USA | Medical students | CNS. Topics: Parkinson's disease, dementia | 1.5 h for both topics together | Integrated lectures, small groups | Yes | Mandatory | ? | ||
| Lathers & Smith (2002) [67] | USA | Medical students, residents | Geriatric clinical pharmacology | 2 h | ‘Clinical pharmacology problem-solving unit’. Case-based learning | Yes | ? | Of 455 students and residents, 40% (range in different years 25–65%) found it useful for learning | 1 | 1 |
| Lim & Honey (2006) [68] | New Zealand | Nursing students | Elderly pharmacokinetics | ? | Integrated, PBL | Yes | Mandatory | ? | ||
| Postgraduate | ||||||||||
| Leikola et al. (2009) [69] | Finland | Pharmacists | Comprehensive medication review, rational prescribing, clinical pharmacology | 935 h (35 ECTS) | Seminars, e-learning, learning in practice | Yes | Elective | Online evaluation (n = 38, response rate 90%): 92% met educational needs, 95% would recommend training to peers | 1 | 1 |
| Demirkan et al. (2004) [35] | Turkey | Pharmacists | Good practice pharmacists, 1 topic: group at risk (geriatric, renal and liver failure) | 7 h | Lectures, workshops | Yes | Elective | 95 pharmacists participated: score on pretest vs. post-test on all topics: 36.1 ± 7.9 vs. 56.6 ± 10.3 | 2b | 3 |
| Strohkirch & Jaehde (2003) [59] | Germany | Pharmacists | Clinical pharmacology | 1 year, 4 modules at university | Practice in own work environment, online support | Yes | Elective | ? | ||
| Warshaw et al. (2010) [70] | USA | GP | Medication management as part of geriatric education | 1.25 h medication management | Presentations | Yes | ? | 60 GPs: response rate 80–93% (over different years). Score 3.8 out of 4 on presentation content, quality and meeting educational needs | 1 | 1 |
| Midlöv et al. (2006) [31] | Sweden | GP | Psychoactive drugs | 2 visits | Outreach visits | No | Decrease in benzodiazepine prescribing after 9 months in intervention group (n = 23) compared with control group (n = 31) (P < 0.05). GP's satisfaction: median 8–10 out of 10 on 6 subjects | 1,4b | 4 | |
| Straand et al. (2006) [71] | Norway | GP | Pharmacotherapeutics | 2 visits, 8 h workshop | Outreach visits, workshops, feedback reports | No | ? | |||
| Pimlott et al. (2003) [32] | Canada | GP | Benzodiazepine use in elderly | 3 times in 6 months | Educational bulletins, feedback on prescriptions | No | Randomisation of physicians. Intervention (n = 168) vs. control group (n = 206): 0.7% decrease vs. 1.1% increase in long-acting benzodiazepine (P = 0.036, not clinically relevant), no other significant differences | 4b | 3 | |
| Lutters et al. (2004) [72] | Switzerland | Hospital physicians | Antibiotics prescriptions in elderly | Weekly ward rounds | Ward rounds with infectious disease specialist, lectures, individual counselling, pocket cards | Yes | Mandatory | Interventional cohort study (before, during and after intervention): 680 patients receiving antibiotics included: 15% reduction in proportion of patients receiving antibiotics (P = 0.08), 26% reduction in number of antibiotics administered (P < 0.001). In 83 of 110 patients, guidelines correctly implemented | 4b | 2 |
| George & Jacobs (2011) [60] | USA | Residents and fellows, medical students | Geriatric pharmacotherapy | 23 times, 1 h sessions | Seminars using the Medication Screening Questionnaire | Yes | ? | Qualitative evaluation of education. 163 of 241 participants. 99% (strongly) agreed that overall quality of the sessions was excellent. All (strongly) agreed on meeting learning goals | 1 | 1 |
| Naughton et al. (2010) [33] | USA | Internal medicine residents | Polypharmacy training as part of NSAID prescribing training | 7 monthly modules | Patient chart review, lectures | Yes | Mandatory | 35 postgraduate internal medicine residents. Pre-intervention vs. postintervention: reduction in NSAID prescribing after 1 year: 29 vs. 16% (P = 0.002) reduction in NSAID and 14 vs. 7% reduction in NSAID in conjunction with a diuretic (P = 0.024) | 4b | 3 |
| Baum & Harder (2010) [34] | Germany | Residents, senior physicians | Renal failure adjustments | 2 h | Lecture | Yes | ? | 8 physicians. 2 patient cohorts: pre-education (n = 85) vs. posteducation (n = 85). Cohort 1, 55 of 85 misdosing vs. cohort 2, 28 of 85 misdosing at day 2 of hospital admission (P = 0.05) | 4b | 3 |
| Montagnini et al. (2004) [73] | USA | Internal medicine residents | Geriatric and palliation rotation | One month rotation. Amount of hours on pharmacology education unclear. | Lectures, bedside teaching, conferences, practice-based learning | Yes | Mandatory | 28 residents completed the evaluation forms (prerotation and postrotation). On palliation topics (including delirium), residents self-assessments increased from 2.89–3.71 to 4.10–4.67 (out of 5). P < 0.00001 | 2b | 2 |
| Lathers & Smith (2002) [67] | USA | Residents (medical, psychiatry), medical studdents | Geriatric clinical psychopharmacology | 2 h | ‘Clinical pharmacology problem-solving unit’. Case-based learning | Yes | ? | Of 455 students and residents, 40% (range in different years 25–65%) found it useful for learning | 1 | 1 |
| Meagher (2010) [74] | UK | Healthcare workers | Pharmacotherapy in delirium | 2 h | Workshop | No | Congress workshop. n = 66 (response rate unknown). Pre-education vs. posteducation on rating adverse events: concerns regarding extrapyramidal side effects reduced (52 vs. 21%; P < 0.001). Posteducation survey on future pharmacotherapy: positive attitude regarding prophylaxis in high-risk patients: 56% respondents. | 2a | 1 | |
Abbreviations: CH, credit hour; CNS, central nervous system; ECTS, European Credit Transfer System; NSAID, nonsteroidal anti-inflammatory drug; GP, General Practitioner; PBL, problem-based learning; and Pharm students, pharmacy students.
*
Modified level of evaluation of Kirkpatrick.
†
Strength of findings after critical appraisal.