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

Drugs Aging. 2012 Aug 1;29(8):659-67. doi: 10.1007/BF03262281.


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) pre-test 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.

MeSH terms

  • Aged, 80 and over
  • Drug Prescriptions / standards*
  • Female
  • Hospitals
  • Humans
  • Inappropriate Prescribing / prevention & control*
  • Polypharmacy*
  • Practice Guidelines as Topic*
  • Uncertainty