Reduction of polypharmacy by feedback to clinicians

Abstract

Objective: To determine whether two different educational interventions would reduce polypharmacy in outpatients receiving ten (10) or more active medications at the Denver Veterans Affairs Center.

Design: 292 patients were randomized into three (3) groups: Control (n = 88); simple notification of primary care provider (n = 102); intensive notification, provision of pharmacy profiles, compliance index, and chart review by senior clinician with recommendations (n = 104).

Setting: Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center.

Patients/participants: All patients receiving greater than ten (10) active medications who are followed by clinic staff at the Denver VAMC. The mean age was 62 years (range 26-88) and 96% were male.

Interventions: The simple notification group received only a single letter recommending that the patient's number of medications be reduced. The intensive notification group received more sophisticated intervention with a chart review, two letters with calculation of patient compliance, and individualized suggestions for reduction in polypharmacy. The control group received no intervention.

Measurements and main results: Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months (p = 0.028). There was no significant difference between the intervention groups (p = 0.189). By six months the difference was no longer significant.

Conclusions: A simple intervention can result in a significant reduction in the number of medications prescribed to patients with polypharmacy. The authors were unable to show that a more complex intervention resulted in a further reduction in polypharmacy.