Appropriate Prescribing for Older People: A New Tool for the General Practitioner.

Abstract

Appropriate prescribing for older people is a challenge. General practitioners (GPs) are aware of their key position in relation to prescribing practice in the elderly. However, they often feel powerless and report a need for simple GP friendly tools to assess and support their prescribing practice. In this study such a tool is developed: the Appropriate Medication for Older people-tool (AMO-tool). The purpose of the study is to investigate whether GPs consider the use of the AMO-tool to be practically feasible and resulting in more appropriate prescribing. This pilot study with an interventional design was conducted over a period of six months. The study was conducted in nursing homes visited by GPs. The studied population consisted of nine GPs and 67 nursing home residents. The intervention consisted of the use of the AMO-tool. The Short Form (SF)-12 questionnaire was administered to the patients. Patients' medication lists were recorded. The GPs completed a semi-quantitative questionnaire on their experiences with the AMO-tool. A descriptive qualitative and semi-quantitative analysis was carried out on the GP questionnaire. The results of the SF-12 questionnaires and medication lists were analysed quantitatively. A multivariate analysis was carried out. In the perception of GPs, applying the AMO-tool to medication lists of nursing home residents was feasible and resulted in more appropriate prescribing. A slight reduction was recorded in the number of medications prescribed. Self-reported well-being improved and rose in parallel with the number of medication changes. According to GPs, the AMO-tool offers GPs the support in their prescribing practice. Changes are made to medication lists and improvements occur in patients' self-reported well-being. Future research should objectify the appropriateness of prescriptions before and after using the tool. Furthermore, it should investigate the possible causal relationship between the use of the AMO-tool, an increase in appropriateness of medication lists and an improvement of general well-being.