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Polypharmacy management in Medicare managed care: changes in prescribing by primary care physicians resulting from a program promoting medication reviews.
Am J Manag Care 1999; 5(5):587-94AJ

Abstract

OBJECTIVE

To examine the effects of medication reviews by primary care physicians on prescriptions written for elderly members of a Medicare managed care organization who were at risk for polypharmacy.

STUDY DESIGN

Prospective study with follow-up survey.

PATIENTS AND METHODS

We conducted a study in 1995 to demonstrate the prevalence of polypharmacy (defined as receiving 5 or more prescription medications during the 3-month study period) among elderly members of our managed care organization. Two years later, elderly members identified as being at risk for polypharmacy were sent a letter encouraging them to schedule a medication review with their primary care physician. Each primary care physician was provided with clinical practice guidelines on polypharmacy and patient-specific medication management reports. Patients and physicians were subsequently mailed a survey to assess the impact of the medication review program on prescribing practices.

RESULTS

Of 37,372 elderly members screened, 5737 (15%) were at risk for polypharmacy. Of these, 2615 (46%) responded to the follow-up survey. Of the survey respondents, 1087 (42%) had gone to their primary care physician for a medication review. During the review, 96% of patients discussed their prescription medications and 72% discussed nonprescription medications they were taking. Twenty percent reported that their physician discontinued medications, 29% reported that the physician changed the dose of a medication, and 17% informed their physician about a new prescription or nonprescription medication they were taking. Of the 275 primary care physicians surveyed, 56 (20%) returned the questionnaire. Of these, 61% reported that the medication review program was "very" or "somewhat useful." Thirty-five percent reported discontinuing unnecessary medications, and 23% reported decreasing the frequency of dosing. Overall, 45% of physicians reported making at least one change in their prescribing to a member at risk for polypharmacy.

CONCLUSIONS

Our program promoting medication reviews between primary care physicians and their elderly patients resulted in significant changes in prescribing by physicians. This type of program is likely to decrease the risk of polypharmacy among older members of a Medicare managed care organization.

Authors+Show Affiliations

Institute for the Study of Aging, New York, NY 10153, USA. hfillit@rslmgmt.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10537865

Citation

Fillit, H M., et al. "Polypharmacy Management in Medicare Managed Care: Changes in Prescribing By Primary Care Physicians Resulting From a Program Promoting Medication Reviews." The American Journal of Managed Care, vol. 5, no. 5, 1999, pp. 587-94.
Fillit HM, Futterman R, Orland BI, et al. Polypharmacy management in Medicare managed care: changes in prescribing by primary care physicians resulting from a program promoting medication reviews. Am J Manag Care. 1999;5(5):587-94.
Fillit, H. M., Futterman, R., Orland, B. I., Chim, T., Susnow, L., Picariello, G. P., ... Warburton, S. W. (1999). Polypharmacy management in Medicare managed care: changes in prescribing by primary care physicians resulting from a program promoting medication reviews. The American Journal of Managed Care, 5(5), pp. 587-94.
Fillit HM, et al. Polypharmacy Management in Medicare Managed Care: Changes in Prescribing By Primary Care Physicians Resulting From a Program Promoting Medication Reviews. Am J Manag Care. 1999;5(5):587-94. PubMed PMID: 10537865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Polypharmacy management in Medicare managed care: changes in prescribing by primary care physicians resulting from a program promoting medication reviews. AU - Fillit,H M, AU - Futterman,R, AU - Orland,B I, AU - Chim,T, AU - Susnow,L, AU - Picariello,G P, AU - Scheye,E C, AU - Spoeri,R K, AU - Roglieri,J L, AU - Warburton,S W, PY - 1999/10/28/pubmed PY - 1999/10/28/medline PY - 1999/10/28/entrez SP - 587 EP - 94 JF - The American journal of managed care JO - Am J Manag Care VL - 5 IS - 5 N2 - OBJECTIVE: To examine the effects of medication reviews by primary care physicians on prescriptions written for elderly members of a Medicare managed care organization who were at risk for polypharmacy. STUDY DESIGN: Prospective study with follow-up survey. PATIENTS AND METHODS: We conducted a study in 1995 to demonstrate the prevalence of polypharmacy (defined as receiving 5 or more prescription medications during the 3-month study period) among elderly members of our managed care organization. Two years later, elderly members identified as being at risk for polypharmacy were sent a letter encouraging them to schedule a medication review with their primary care physician. Each primary care physician was provided with clinical practice guidelines on polypharmacy and patient-specific medication management reports. Patients and physicians were subsequently mailed a survey to assess the impact of the medication review program on prescribing practices. RESULTS: Of 37,372 elderly members screened, 5737 (15%) were at risk for polypharmacy. Of these, 2615 (46%) responded to the follow-up survey. Of the survey respondents, 1087 (42%) had gone to their primary care physician for a medication review. During the review, 96% of patients discussed their prescription medications and 72% discussed nonprescription medications they were taking. Twenty percent reported that their physician discontinued medications, 29% reported that the physician changed the dose of a medication, and 17% informed their physician about a new prescription or nonprescription medication they were taking. Of the 275 primary care physicians surveyed, 56 (20%) returned the questionnaire. Of these, 61% reported that the medication review program was "very" or "somewhat useful." Thirty-five percent reported discontinuing unnecessary medications, and 23% reported decreasing the frequency of dosing. Overall, 45% of physicians reported making at least one change in their prescribing to a member at risk for polypharmacy. CONCLUSIONS: Our program promoting medication reviews between primary care physicians and their elderly patients resulted in significant changes in prescribing by physicians. This type of program is likely to decrease the risk of polypharmacy among older members of a Medicare managed care organization. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/10537865/Polypharmacy_management_in_Medicare_managed_care:_changes_in_prescribing_by_primary_care_physicians_resulting_from_a_program_promoting_medication_reviews_ L2 - https://www.ajmc.com/pubMed.php?pii=1352 DB - PRIME DP - Unbound Medicine ER -