Researchers at the Jefferson School of Population Health, working with colleagues at the Parma Local Health Authority in Italy, significantly reduced the prescribing of dangerous medications for older people during a three year, proof-of-concept study. The study was so successful that enrollees adopted its practices permanently.
The Jefferson School of Population Health will conduct a reporters’ conference call on January 23, 2013 at 9:30 AM EST. The study’s three co-authors, Vittorio Maio, PharmD, MS, MSPH (a Jefferson pharmacology expert); Scott Keith, PhD (a Jefferson biostatistician); and Stefano Del Canale, MD, PhD (a practicing physician in Parma) will discuss their work.
The rate of Potentially Inappropriate Medications (PIMs) dropped by 9.8 percent during the study. PIMs were reduced by 31.4 percent in Parma and 21.6 percent in the control community. Investigators believe that a third of that reduction (9.8 percent) was directly caused by the study interventions. The report appears in the current issue of the journal Drugs and Aging.
The study’s implications are dramatic for the US and other developed nations. In the US, 30 percent of all medications are prescribed for people over the age of 65. An Institute of Medicine study identified $21 billion in annual US healthcare spending caused by medication errors. Outpatient preventable medication errors cost $4.2 billion per year.
Parma was chosen because people in Italy have universal health coverage, a uniform system easier to study than the one in the United States. Rather than focus on educating patients, researchers sought to change the behavior of physicians, each of whom treats hundreds of patients.
"The public doesn’t realize how many elderly patients are exposed every day to potentially dangerous medications that can severely affect their health," said Vittorio Maio, PharmD, MS, MSPH an author of the study. “Changing physician behavior is very difficult, but we showed it can be done.”
Jefferson and Parma researchers were able to reduce the prescribing of dangerous medications by 9.8 percent. This decrease in prescribing of the Beers List of PIMS could translate into hundreds of millions of dollars saved each year and thousands of health problems averted among the elderly.
“Elderly people are using so many medications that the choice of safe ones is an issue of paramount importance. Older people often ask their doctors for additional drugs for pain relief, but some of these drugs can be toxic for frail patients,” commented Dr. Del Canale.
The study engaged all 303 general practitioners in the Local Health Authority in Parma Italy, who together treat a total of about 100,000 people over age 65. Investigators first distributed the list of PIMs to the general practitioners, established a baseline level at which they were being prescribed, then conducted educational sessions with the general practitioners. Later, they tested the incidence with which general practitioners were still prescribing the PIMs. They also studied a very similar community nearby as a control group. After these interventions, prescribing of PIMs in Parma had dropped by 9.8 percent.
“Prescribing potentially dangerous medications to older adults is a serious, but preventable problem worldwide. Our efforts in Parma, Italy to change prescribing behaviors spared over 600 people exposure to these drugs in the Fall of 2009 alone,” said Dr. Keith.
Many practitioners are still unfamiliar with the PIM list, which includes commonly used medications such as ibuprofen, amitriptyline, and digoxin. Here is a recent update of the list: http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf
Studies put the number of patients in the US killed by medication errors at between 48,000 to 98,000 per year or more.