Randomized controlled trial of an intervention to improve drug appropriateness in community-dwelling polymedicated elderly people

Background. Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems. Objectives. To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people. Design. Randomized, open-label, multicentre, parallel-arm clinical trial with 1-year follow-up. Setting. Primary care centres. Participants. Polymedicated (>= 8 drugs) elderly people (>= 70 years). Study intervention. Pharmacist review of all medication according to the Good Palliative-Geriatric Practice algorithm and the Screening Tool of Older Person's Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient's physician. Control intervention. Routine clinical practice. Measurements. Recommendations and changes implemented, number of prescribed drugs, restarted drugs, primary care and emergency department consultations, hospitalizations and death. Results. About 503 (252 intervention and 251 control) patients were recruited and 2709 drugs were evaluated. About 26.5% of prescriptions were rated as potentially inappropriate and 21.5% were changed (9.1% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription). About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6% of patients. The mean number of prescriptions per patient was significantly lower in the intervention group at 3-and 6-month follow-up. Discontinuations, dose adjustments and substitutions were significantly higher than in the control group at 3, 6 and 12 months. No differences were observed in the number of emergency visits, hospitalizations and deaths. Conclusion. The study intervention was safe, reduced potentially inappropriate medication, but did not reduce emergency visits and hospitalizations in polymedicated elderly people.