Effects of a drug minimization guide on prescribing intentions in elderly persons with polypharmacy

Scott, Ian A., Gray, Leonard C., Martin, Jennifer H. and Mitchell, Charles A. (2012) Effects of a drug minimization guide on prescribing intentions in elderly persons with polypharmacy. Drugs and Aging, 29 8: 659-667. doi:10.2165/11632600

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Author Scott, Ian A.
Gray, Leonard C.
Martin, Jennifer H.
Mitchell, Charles A.
Title Effects of a drug minimization guide on prescribing intentions in elderly persons with polypharmacy
Journal name Drugs and Aging   Check publisher's open access policy
ISSN 1170-229X
Publication date 2012-08
Sub-type Article (original research)
DOI 10.2165/11632600
Volume 29
Issue 8
Start page 659
End page 667
Total pages 9
Place of publication Auckland, New Zealand
Publisher Adis International
Collection year 2013
Language eng
Formatted abstract
Background: While frameworks exist to assist clinicians in prescribing appropriately in older patients at risk of adverse drug reactions, their impact on prescribing is uncertain.
Objective: The aim of the study was to determine the effects of a ten-step drug minimization guide on clinician prescribing intentions involving a hypothetical older patient receiving multiple drugs.
Methods: A total of 61 hospital clinicians were presented with clinical information about a hypothetical case: an 81-year-old female with 12 chronic diseases, receiving 19 different medications. On a standardized, anonymous form, each participant indicated, as a pre-test, which drugs they felt strongly inclined to discontinue or continue, and which drugs they were uncertain about. The ten-step guide was then presented and applied to the case, and participants repeated the drug selection process.
Results: Sixty evaluable forms were analysed from 19 consultant physicians, 17 medical registrars, 7 interns/residents and 17 pharmacists. Among the entire cohort, the mean (–SD) number of drugs selected for discontinuation increased from 6.0 (–2.7) pre-test to 9.6 (–3.2) post-test (p < 0.001), with the greatest increases seen among consultant physicians (6.6 [–2.3] to 11.5 [–2.9], p < 0.001) and clinical pharmacists (5.3 [–2.6] to 8.9 [–2.2], p < 0.001). The number of drugs associated with uncertainty decreased from 3.7 (–2.9) pretest to 1.8 (–2.3) post-test (p < 0.001) for the whole cohort, with the greatest decreases seen among consultant physicians (4.8 [–2.6] to 1.8 [–2.5], p < 0.001) and clinical pharmacists (4.5 [–3.3] to 1.9 [–2.0], p = 0.003).
Conclusion: This self-report study involving a hypothetical case provides evidence that a drug minimization guide may reduce inappropriate prescribing and uncertainty around drug indications.
Keyword Beers criteria
Older patients
Medication use
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
School of Pharmacy Publications
UQ Diamantina Institute Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
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