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Academic Detailing with Provider Audit and Feedback Improve Prescribing Quality for Older Veterans
Author(s) -
Vandenberg Ann E.,
Echt Katharina V.,
Kemp Lawanda,
McGwin Gerald,
Perkins Molly M.,
Mirk Anna K.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15247
Subject(s) - medicine , academic detailing , polypharmacy , family medicine , audit , intervention (counseling) , geriatrics , quality management , pharmacist , outreach , specialty , emergency department , benchmarking , nursing , psychiatry , pharmacy , management system , business , management , marketing , political science , law , economics
Suboptimal prescribing persists as a driver of poor quality care of older veterans and is associated with risk of hospitalization and emergency department visits. We adapted a successful medication management model, Integrated Management and Polypharmacy Review of Vulnerable Elders ( IMPROVE ), from an urban geriatric specialty clinic to rural community‐based clinics that deliver primary care. The goals were to promote prescribing quality and safety for older adults, including reduced prescribing of potentially inappropriate medications ( PIM s). We augmented the original model, which involved a pharmacist‐led, one‐on‐one medication review with high‐risk older veterans, to provide rural primary care providers ( PCP s) and pharmacists with educational outreach through academic detailing and tools to support safe geriatric prescribing practices, as well as individual audit and feedback on prescribing practice and confidential peer benchmarking. Twenty PCP s and 4 pharmacists at 4 rural Georgia community‐based outpatient clinics participated. More than 7,000 older veterans were seen in more than 20,000 PCP encounters during the 14‐month intervention period. Implementation of the IMPROVE intervention reduced PIM prescribing incidence from 9.6 new medications per 100 encounters during baseline to 8.7 after the intervention ( P = .009). IMPROVE reduced PIM prevalence (proportion of encounters involving veterans who were taking at least 1 PIM ) from 22.6% to 16.7% ( P < .001). These approaches were effective in reducing PIM s prescribed to older veterans in a rural setting and constitute a feasible model for disseminating geriatric best practices to the primary care setting.