The Quality of Polypharmacy Management

Abstract

Polypharmacy is commonly seen among the elderly and its management is difficult. The adverse effects of medications can contribute to conditions such as delirium, falls, sedative and/or anticholinergic properties, and are common causes of morbidity and hospitalisation. Little is known about the relation between the quality of prescriptions and the patient-indices: Drug Burden Index (DBI), Delier, Fall, Sedative and Anticholinergic burden (ACB). We hypothesise that the quality of polypharmacy management – operationalised through the alerts of a Clinical Decision Support System (CDSS) – is correlated to patient-indices. In a primary care setting, patients aged >60 taking five or more drugs were selected. Their medications were analysed by a CDSS, consisting of 469 drug safety rules. Developed to support medication reviews. CDSS gives a red-alert in case medication was wrong and a green-alert when no problem was encountered. We looked for a correlation between the patient-indices and the CDSS-alerts, eg number of red-alerts per patient (R), number of green-alerts per patient (G), R/R+G. We analyzed 751 patients from 24 general practices. The CDSS generated 11,559 alerts; 1489 red alerts and 10,070 green-alerts. Table. Correlation between number of alerts and patient-indices.Tabled 1DBIACBdelierFallSedR/R+G–0,40473–0,3530,232574–0,15581–0,27803R–0,12207–0,121970,3469740,064280,012146G0,5907480,510860,1727360,3484160,547824 Open table in a new tab In the present study several indices were associated with a negative correlation, where we expected a positive correlation (eg more red-alerts, an higher DBI). Delirium had a positive correlation with R, but this was too low. We expected a negative correlation between G and the indices, but this appeared to be positively correlated. We concluded that we did not find the expected correlation between the CDSS-alerts and the patient indices.