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.
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