Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009;26(8):687-701.
doi: 10.2165/11316400-000000000-00000.

Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy: results of application to case histories by general practitioners

A Clara Drenth-van Maanen  1 , Rob J van Marum, Wilma Knol, Carolien M J van der Linden, Paul A F Jansen
Affiliations

Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy: results of application to case histories by general practitioners

A Clara Drenth-van Maanen et al. Drugs Aging. 2009.

Abstract

Background: Optimizing polypharmacy is often difficult, and critical appraisal of medication use often leads to one or more changes. We developed the Prescribing Optimization Method (POM) to assist physicians, especially general practitioners (GPs), in their attempts to optimize polypharmacy in elderly patients. The POM is based on six questions: (i) is undertreatment present and addition of medication indicated; (ii) does the patient adhere to his/her medication schedule; (iii) which drug(s) can be withdrawn or which drugs(s) is/are inappropriate for the patient; (iv) which adverse effects are present; (v) which clinically relevant interactions are to be expected; and (vi) should the dose, dose frequency and/or form of the drug be adjusted?

Objective: The aim of this study was to evaluate the usefulness of the POM as a tool for improving appropriate prescribing of complex polypharmacy in the elderly.

Methods: Forty-five GPs were asked to optimize the medication of two case histories, randomly chosen from ten histories of geriatric patients admitted to a hospital geriatric outpatient clinic with a mean +/- SD of 7.9 +/- 1.2 problems treated with 8.7 +/- 3.1 drugs. The first case was optimized without knowledge of the POM. After a 2-hour lecture on the POM, the GPs used the POM to optimize the medication of the second case history. The GPs were allowed 20 minutes for case optimization. Medication recommendations were compared with those made by an expert panel of four geriatricians specialized in clinical pharmacology. Data were analysed using a linear mixed effects model.

Results: Optimization was significantly better when GPs used the POM. The proportion of correct decisions increased from 34.7% without the POM to 48.1% with the POM (p = 0.0037), and the number of potentially harmful decisions decreased from a mean +/- SD of 3.3 +/- 1.8 without the POM to 2.4 +/- 1.4 with the POM (p = 0.0046).

Conclusion: The POM improves appropriate prescribing of complex polypharmacy in case histories.

PubMed Disclaimer

References

    1. Am J Med. 2004 Mar 15;116(6):394-401 - PubMed
    1. Clin Pharmacol Ther. 1981 Aug;30(2):239-45 - PubMed
    1. Clin Ther. 2001 Aug;23(8):1296-310 - PubMed
    1. Lancet. 2007 Jul 14;370(9582):173-184 - PubMed
    1. Nihon Ronen Igakkai Zasshi. 2000 May;37(5):363-70 - PubMed

LinkOut - more resources