Academic Detailing with Provider Audit and Feedback Improve Prescribing Quality for Older Veterans

Academic Detailing with Provider Audit and Feedback Improve Prescribing Quality for Older Veterans Suboptimal prescribing for older adults in primary care is common and is associated with risk of adverse events requiring emergency department visits or hospitalization. The Veterans Health Administration (VHA) serves a large population of older adults, with 47% of beneficiaries aged 65 and older. VHA rates of adverse drug events are similar to those of other health systems. Multiple studies use exposure to potentially inappropriate medications (PIMs) as a proxy for poor quality prescribing and adverse outcomes. PIMs in older adults include medications with high risk of adverse events because of their pharmacological properties (e.g., highly anticholinergic medications), physiological changes of aging (e.g., poor renal clearance), or poor evidence of efficacy in older adults. Nationally, 21.3% of veterans aged 65 and older received a PIM during 18 months in 2002–03, compared with 28.8% of private‐sector health maintenance organization enrollees during a similar period. Some of the poorest quality prescribing is experienced in the rural South, where veterans were 22% as likely to be prescribed a PIM as their urban‐dwelling counterparts.To address suboptimal prescribing, the VHA Geriatrics Pharmacy Taskforce recommended in 2011 that facilities offer “individualized pharmacy review for high‐risk patients on multiple medications,” similar to requirements for Medicare Part D http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of American Geriatrics Society Wiley

Academic Detailing with Provider Audit and Feedback Improve Prescribing Quality for Older Veterans

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Publisher
Wiley
Copyright
© 2018 American Geriatrics Society and Wiley Periodicals, Inc.
ISSN
0002-8614
eISSN
1532-5415
D.O.I.
10.1111/jgs.15247
Publisher site
See Article on Publisher Site

Abstract

Suboptimal prescribing for older adults in primary care is common and is associated with risk of adverse events requiring emergency department visits or hospitalization. The Veterans Health Administration (VHA) serves a large population of older adults, with 47% of beneficiaries aged 65 and older. VHA rates of adverse drug events are similar to those of other health systems. Multiple studies use exposure to potentially inappropriate medications (PIMs) as a proxy for poor quality prescribing and adverse outcomes. PIMs in older adults include medications with high risk of adverse events because of their pharmacological properties (e.g., highly anticholinergic medications), physiological changes of aging (e.g., poor renal clearance), or poor evidence of efficacy in older adults. Nationally, 21.3% of veterans aged 65 and older received a PIM during 18 months in 2002–03, compared with 28.8% of private‐sector health maintenance organization enrollees during a similar period. Some of the poorest quality prescribing is experienced in the rural South, where veterans were 22% as likely to be prescribed a PIM as their urban‐dwelling counterparts.To address suboptimal prescribing, the VHA Geriatrics Pharmacy Taskforce recommended in 2011 that facilities offer “individualized pharmacy review for high‐risk patients on multiple medications,” similar to requirements for Medicare Part D

Journal

Journal of American Geriatrics SocietyWiley

Published: Jan 1, 2018

Keywords: ; ; ; ;

References

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