Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Schmader, K. E., Hanlon, J. T., Pieper, C. F., Sloane, R., Ruby, C. M., Twersky, J., Francis, S. D., Branch, L. G., Lindblad, C. I., Artz, M., Weinberger, M., Feussner, J. R., & Cohen, H. J. The American Journal of Medicine, 116(6):394–401, March, 2004. doi abstract bibtex PURPOSE: To determine if inpatient or outpatient geriatric evaluation and management, as compared with usual care, reduces adverse drug reactions and suboptimal prescribing in frail elderly patients. METHODS: The study employed a randomized 2 x 2 factorial controlled design. Subjects were patients in 11 Veterans Affairs (VA) hospitals who were \textgreater or =65 years old and met criteria for frailty (n = 834). Inpatient geriatric unit and outpatient geriatric clinic teams evaluated and managed patients according to published guidelines and VA standards. Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse. RESULTS: For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95% confidence interval: 0.45 to 0.93). Inpatient geriatric unit care reduced unnecessary and inappropriate drug use and underuse significantly during the inpatient period (P \textless0.05). Outpatient geriatric clinic care reduced the number of conditions with omitted drugs significantly during the outpatient period (P \textless0.05). CONCLUSION: Compared with usual care, outpatient geriatric evaluation and management reduces serious adverse drug reactions, and inpatient and outpatient geriatric evaluation and management reduces suboptimal prescribing, in frail elderly patients.
@article{schmader_effects_2004,
title = {Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly},
volume = {116},
issn = {0002-9343},
doi = {10.1016/j.amjmed.2003.10.031},
abstract = {PURPOSE: To determine if inpatient or outpatient geriatric evaluation and management, as compared with usual care, reduces adverse drug reactions and suboptimal prescribing in frail elderly patients.
METHODS: The study employed a randomized 2 x 2 factorial controlled design. Subjects were patients in 11 Veterans Affairs (VA) hospitals who were {\textgreater} or =65 years old and met criteria for frailty (n = 834). Inpatient geriatric unit and outpatient geriatric clinic teams evaluated and managed patients according to published guidelines and VA standards. Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse.
RESULTS: For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35\% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95\% confidence interval: 0.45 to 0.93). Inpatient geriatric unit care reduced unnecessary and inappropriate drug use and underuse significantly during the inpatient period (P {\textless}0.05). Outpatient geriatric clinic care reduced the number of conditions with omitted drugs significantly during the outpatient period (P {\textless}0.05).
CONCLUSION: Compared with usual care, outpatient geriatric evaluation and management reduces serious adverse drug reactions, and inpatient and outpatient geriatric evaluation and management reduces suboptimal prescribing, in frail elderly patients.},
language = {eng},
number = {6},
journal = {The American Journal of Medicine},
author = {Schmader, Kenneth E. and Hanlon, Joseph T. and Pieper, Carl F. and Sloane, Richard and Ruby, Christine M. and Twersky, Jack and Francis, Susan Dove and Branch, Laurence G. and Lindblad, Catherine I. and Artz, Margaret and Weinberger, Morris and Feussner, John R. and Cohen, Harvey Jay},
month = mar,
year = {2004},
pmid = {15006588},
keywords = {Aged, Case Management, Drug Utilization Review, Drug-Related Side Effects and Adverse Reactions, Female, Frail Elderly, Geriatric Assessment, Health Services Misuse, Hospital Units, Hospitals, Veterans, Humans, Male, Medication Errors, Multivariate Analysis, Outcome Assessment (Health Care), Outpatient Clinics, Hospital, Regression Analysis, United States},
pages = {394--401}
}
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Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse. RESULTS: For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95% confidence interval: 0.45 to 0.93). Inpatient geriatric unit care reduced unnecessary and inappropriate drug use and underuse significantly during the inpatient period (P \\textless0.05). Outpatient geriatric clinic care reduced the number of conditions with omitted drugs significantly during the outpatient period (P \\textless0.05). 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Subjects were patients in 11 Veterans Affairs (VA) hospitals who were {\\textgreater} or =65 years old and met criteria for frailty (n = 834). Inpatient geriatric unit and outpatient geriatric clinic teams evaluated and managed patients according to published guidelines and VA standards. Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse.\nRESULTS: For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35\\% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95\\% confidence interval: 0.45 to 0.93). 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