Premium
Strategies Against Polypharmacy and Inappropriate Medication ‐ Are they Effective?
Author(s) -
Chan FHW,
Pei CKW,
Chiu K C.,
Tsang EKW
Publication year - 2001
Publication title -
australasian journal on ageing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.63
H-Index - 34
eISSN - 1741-6612
pISSN - 1440-6381
DOI - 10.1111/j.1741-6612.2001.tb00359.x
Subject(s) - polypharmacy , medicine , emergency medicine , medical record , drug reaction , retrospective cohort study , incidence (geometry) , medical diagnosis , pediatrics , drug , psychiatry , physics , pathology , optics
Objectives : To evaluate the effectiveness of a drug rationalization programme in reducing the incidence of polypharmacy and inappropriate medication since an initial survey performed in the previous year. Method : A retrospective case notes study was performed on patients discharged from the medical! geriatrics wards during the period from 1st of July 1997 to 30th of September 1997. This was exactly one year after the initial study followed by the implementation of a drug rationalization programme. Data collection was carried out by the same two medical staff using a data collection sheet. Data collected included patient's sex, age, length of stay, diagnoses, medication on discharge (whether appropriate or inappropriate) and adverse drug reactions (ADRs).Results : The total number of cases was 210. 39.5% of cases were male while 60.5% were female. The mean age was 80.2 years (min. 59 and max. 103). The mean length of stay was 22.72 days (min. 2 and max. 148). The mean number of active and inactive diagnoses on discharge was 0.69 and 3.36 respectively. The mean number of medication on admission was 4.65. The mean number of inappropriate medication on admission was 0.50 per patient. The number of patients with inappropriate medication(s) on admission was 73 (34.8% of patients) with 10.86% of all medications prescribed on admission being inappropriate. The mean number of medication on discharge was 3.56, and the mean number of inappropriate medication was reduced to 0.13 per patient. The number of patients with inappropriate medication(s) on discharge was reduced to 26 (12.4% of patients) with 3.62% of all medications prescribed on discharge being inappropriate. The most frequent class of inappropriate medication was drugs for the respiratory system both on admission and discharge at 35.5% and 48.2% respectively. The commonest reason for being an inappropriate medication was the use of drug, which had no apparent indication both on admission and discharge at 70.2% and 50% respectively. There were 16 incidences of ADRs found in 15 patients (min. 1, max. 2 and mean of 0.076 per patients).Conclusion : This study had demonstrated the effectiveness of our drug rationalization programme. The percentage of inappropriate medication on discharge was significantly reduced from the previous study's 18.03% to this study's 3.62%. The percentage of inappropriate medication was also reduced from 10.86% on admission to 3.62% on discharge in this study. Education of physicians, as well as patients, is much needed.