Table 2.
Randomized Controlled Studies Designed to Improve Medication Quality in Older Adults using Multiple Medications
| Study | Setting | Patients/Inclusion Criteria | Intervention (Duration) | Process Measures (I vs. C) | Clinical Outcome Measures (I vs. C) |
|---|---|---|---|---|---|
| Pharmacist | Interventions | ||||
| Hanlon, 1996 | 1 VA general medicine clinic, USA | 208 age ≥65 taking ≥5 medications | Pharmacist review, written drug recommendations to PCP and patient counseling at each clinic visit; (12 months) | ↓ MAI score (12.8 vs. 16.7, P<.001) (Lower is better) | NS differences in HRQOL or ADEs (30% vs. 40%) or; health care costs ($7873 vs. $5926) |
| Krska, 2001 | 6 general practices, Scotland | 332 age ≥65 with ≥4 medications and ≥2 chronic disease states | Pharmacist review of medication related issues; pharmacist implemented recommendations agreed to by patient's GP; 3mos | ↑ resolution of monitoring issues, ineffective therapy (83% vs. 41%, P<.001) | NS differences in medication costs, HRQOL, clinic visits, hospitalizations |
| Crotty, 2004 | 85 LTCFs, Australia | 110 hospitalized patients age ≥65 transferred to a LTCF; Average # of medications 8.7 | Pharmacist summary of medications at hospital d/c given to community pharmacist, MD and nurse; Pharmacist conducted drug review discussed at case conference | Better MAI score (2.5 vs 6.5, p<<0.001) | ↓ pain, NS differences in ADEs, falls, mobility, behavior, confusion, ER/hospitalizations |
| Multidisciplinary | Team | Intervention | |||
| Schmader, 2004 | Clinics at 11 VA medical centers, USA | 834 frail persons age ≥65 after hospital discharge (mean ≥10 medications) | Multidisciplinary, protocol-driven GEM clinic; (12 months) | NS difference in # of unnecessary drugs, # of inappropriate drugs, or MAI score (P>.25 for each), ↓ number of conditions with omitted drugs (↓ 0.2 vs. ↑0.1, P<.001) | NS difference in all ADEs (RR 1.03; P=.75);↓ risk of serious ADEs (RR 0.65; P=.02) |
| Crotty, 2004 | 10 LTCFs, Australia | 154 patients age ≥65 with mean ≥5.9 medications | Case conference with MDs, pharmacist, care worker, dementia expert | ↑ change in MAI score (4.1 vs 0.4, P<.001) | NS differences in behavior |
Abbreviations: ADE(Adverse Drug Event), C (Control Group), D/C(Discontinue), GEM (Geriatric Evaluation Management), GP (General Practitioner), HRQOL(Health Related Quality of Life), I (Interventio), LTCF (Long Term Care Facility), MAI (Medication Appropriateness Index), MD (Doctor of Medicine), NS (Non-significant), PCP(Primary Care Physician), RR(Relative Risk), VA (Veteran's Administration), MOS (months)