Context.— Pharmacotherapy is among the most powerful interventions to improve
health outcomes in the elderly. However, since some medications are less appropriate
for older patients, systems approaches to improving pharmacy care may be an
effective way to reduce inappropriate medication use.
Objective.— To determine whether a computerized drug utilization review (DUR) database
linked to a telepharmacy intervention can improve suboptimal medication use
in the elderly.
Design.— Population-based cohort design, April 1, 1996, through March 31, 1997.
Setting.— Ambulatory care.
Patients.— A total of 23269 patients aged 65 years and older throughout the United
States receiving prescription drug benefits from a large pharmaceutical benefits
manager during a 12-month period.
Intervention.— Evaluation of provider prescribing through a computerized online DUR
database using explicit criteria to identify potentially inappropriate drug
use in the elderly. Computer alerts triggered telephone calls to physicians
by pharmacists with training in geriatrics, whereby principles of geriatric
pharmacology were discussed along with therapeutic substitution options.
Main Outcome Measures.— Contact rate with physicians and change rate to suggested drug regimen.
Results.— A total of 43007 alerts were triggered. From a total of 43007 telepharmacy
calls generated by the alerts, we were able to reach 19368 physicians regarding
24266 alerts (56%). Rate of change to a more appropriate therapeutic agent
was 24% (5860), but ranged from 40% for long half-life benzodiazepines to
2% to 7% for drugs that theoretically were contraindicated by patients' self-reported
history. Except for rate of change of β-blockers in patients with chronic
obstructive pulmonary disease, all rates of change were significantly greater
than the expected baseline 2% rate of change.
Conclusions.— Using a system integrating computers, pharmacists, and physicians, our
large-scale intervention improved prescribing patterns and quality of care
and thus provides a population-based approach to advance geriatric clinical
pharmacology. Future research should focus on the demonstration
of improved health outcomes resulting from improved prescribing choices for