Alternatives for Potentially Inappropriate Medications in the Elderly Population: Treatment Algorithms for Use in the Fleetwood Phase III Study

Abstract

To provide estimates of the prevalence of potentially inappropriate medications used in eligible nursing facilities, to describe the development of evidence-based treatment algorithms for recommending safer alternative treatments to potentially inappropriate medications, and to provide the actual treatment algorithms developed for the Fleetwood Phase III study. Literature review, cross-sectional design. Thirty North Carolina nursing facilities eligible for Fleetwood Phase III. Algorithms developed for use by all pharmacists in the long-term care pharmacy serving the intervention facilities site for the Fleetwood Phase III study. Pharmacists are prospectively intervening directly with the prescriber to recommend a safer alternative to inappropriate medications using the standardized treatment algorithms developed for the study. Prevalence of potentially inappropriate medications used among residents and the development of 14 treatment algorithms suggesting appropriate alternatives to inappropriate medications. The percentage of potentially inappropriate medications used ranged from 0% to 13.2% at baseline in March 2002. We also found that evidence-based treatment algorithms were well received by consultant pharmacists at the intervention sites of the Fleetwood Phase III study. We have provided prevalence rates of potentially inappropriate medication use in nursing homes and developed treatment algorithms for pharmacists to use when making clinical recommendations regarding safer alternatives to potentially inappropriate medications in the elderly population. We are in the process of evaluating the effect of pharmacists' prospective interventions by using these standardized evidence-based treatment algorithms to reduce the prevalence of inappropriate medication use in intervention facilities.