095 Analysis of the prescription of aged patients on polymedication in general practice

Abstract

Polymedication among the elderly is associated with an increased iatrogenic morbidity. Few studies have estimated this poly medication in general practice, and explored the possibility of a reduction in the number of prescribed drugs within the framework of a regular patient's follow up by his usual General Practitioner.Furthermore, little data has been published on the increase in cost of care linked to Poly medication among the elderly,The objectives of this program were to measure the impact of a General Practitioner led intervention on their prescription decisions among their poly medicated elderly patients.The program was defined by a group of General Practitioners working in their own private practice in a rural area in eastern France (Department of the Ardennes).This group of 12 practitioners has been meeting on a voluntary basis, with no financial incentive every 6 weeks for the last 4 years in order to share and improve their own professional practices and medical decision making processes. The group is animated by two general practitioners from public and private insurance companies (MSA and Groupama). The group of GPs identified poly medication as a priority issue that could improve their daily medical practice.The program consisted in the identification of their polymedicalised elderly patients with the objective of re evaluating their prescription drugs. This re evaluation was made by GPs for their own patients, after debate within the group, and following HAS's PMSA programs, which had been presented to the group by un expert of this institution.Within this framework, an intervention study was implemented. Each participating practitioner (n=8) included the first 15 poly medicated patients he encountered in his daily practice starting at a defined date. The inclusion criterions were the following: patients aged 70 or more, and having eight or more of prescription drugs. At the time of inclusion, the practitioner completed a set of information about each patient, including the patient's demographic characteristic (age and sex), information about their current chronic diseases and their cardiovascular risk factors.The creatinin clearance was also collected for each patient, calculated according to the Cockcroft et Gault formula.Patients were followed until the end of the study in June 2009, at which date the general practitioners filled in the second part of the survey and collected the same set of information regarding his prescriptions as the inclusion data. Reasons for changes of prescriptions were recorded as well.Overall, 120 patients were included in the study. Two patients died during the follow-up, and thus were not included in the analysis. The analysis comprised 118 patients, followed for an average of 262 days. Upon entry in the study, the average number of prescribed molecules was 9.4 (SE, 1,99). At the end of the study, the average number of prescribed molecules was 7.7 (SE, 2.2), resulting in an average reduction of 1.7 drugs (IC95%, 1.4–2).This reduction was significantly higher for patie...