POLYPHARMACY IN ELDERLY PATIENTS: AN INTERVENTION STUDY IN THERAPEUTIC MANAGEMENT

Introduction and Objectives The increase in average life expectancy has over time resulted in a rising incidence of chronic degenerative diseases and consequent polypharmacy with an augmented risk of Adverse Drug Reactions (ADRs) and inappropriate prescriptions. We conducted a qualitative and quantitative analysis of polypharmacy in elderly patients, evaluating the risk of ADRs, drug interactions and therapeutic errors before and after adequate staff training aimed at reducing the number of administered drugs and ADRs. Methods 750 elderly patients living in nursing homes in the province of Pordenone, average age 85 (65-103), were enrolled in the study, which lasted for 3 years (2013-2015) and included 3 phases. Phase 1: Medical record audit, data collection of drug therapy and drug management, data analysis, problems detection and planning for adequate training. Phase 2: Multidisciplinary staff training (nurses, general practitioners, specialist doctors, pharmacists) and creation of adequate operative tools (“Do not crush list”, a specific handbook). Phase 3: Second data collection and analysis of drug management and therapy. Results and Conclusions The interventions reduced the proportion of patients in therapy with more than 5 medications by 2%, the practice of crushing medications by 6%, pharmacologic interactions by 7% and also ADR related hospital admissions. The study demonstrated how health personnel training can impact upon medication management in nursing homes. The most significant variations were evident in structures in which it was possible to modify nursing and medical management in a multidisciplinary approach.