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Medication Use in the Seniors Population: Optimization of Physician Prescribing as a Means of Preventing Drug-related Illness

Published online by Cambridge University Press:  08 November 2023

Robyn Tamblyn
Robyn Tamblyn*
Affiliation:
McGill University
*
Requests for reprints should be sent to:/Les demandes de reproduction doivent être adressées à: Robyn Tamblyn, Division of Clinical Epidemiology, McGill University, Royal Victoria Hospital, 687 Pine Avenue West R4.29, Montreal, PQ H3A 1A1
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Abstract

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Drug-related illness (DRI) is a common problem in the elderly. Misuse of medications and inappropriate prescribing account for over half of all hospital admissions for DRI and both are potentially preventable. Physicians are the gatekeepers to prescription medication access and, in this role, they have the opportunity to prevent exposure to unnecessary and inappropriate medication and influence the use of medications by their elderly patients. Effective interventions to improve physician prescribing have been identified but they are costly to introduce, they require ongoing maintenance to maintain their effectiveness, they do not address the problems created by multiple prescribers or the challenges of keeping up-to-date on the growing number of new drugs that enter the market each year. Computer-based drug information networks and expert decision-making support systems are proposed as one means of providing (1) an accurate record for the prescribing physicians of drugs currently dispensed to their elderly patients, (2) a review of problems in existing and new prescriptions, and (3) an expert resource to select drug treatment. Canada is in an ideal situation to pioneer the development of these systems, but to do so, policies need to be put in place to address three problems. First, there is inadequate information available about the risks and benefits of drugs in the elderly because older sicker adults are often excluded in clinical trials of drug-effectiveness. Requirements for drug approval need to be amended so that sufficient evaluation of the risks and benefits of new drugs are carried out in the elderly. Second, computerization in the health care sector is central to the development of electronic decision-support systems in health care delivery. Future policy needs to be directed to the development of an effective infrastructure to facilitate the transition to an integrated computerized health sector. Third, the ethical and legal issues related to the access of prescription data through electronic networks need to be identified and clear guidelines for use of this new technology need to be developed.

Résumé

Résumé

Les maladies reliées aux médicaments (MRM) sont fréquentes chez les aînés. La mauvaise utilisation des médicaments et la prescription d'ordonnances potentiellement non appriopriées (OPNA) sont responsables de plus de la moitié des admissions hospitalières reliées aux MRM. Ceci pourrait être évité. Les médecins contrôlent l'accés aux médicaments d'ordonnance. Ils peuvent done prévenir I'exposition des patients agés aux médicaments inutiles et aux OPNA, et influer sur l'utilisation des medicaments par leurs patients. On a identifié certaines interventions efficaces pour améliorer les habitudes de prescription chez les médecins. Mais leur implantation est coûteuse. Elles doivent être maintenues de façon continue pour conserver leur efficacité. Elles sont inopérantes sur les OPNA généres par des prescripteurs multiples. Elles ne permettent pas au médecin de rester a jour sur le nombre croissant de médicaments qui font leur entrée sur le marché chaque année. On propose ici d'utiliser les technologies informatiques de réseautage et d'aide à la décision pour offrir aux médecins prescripteurs (1) des informations précises et actualisées sur les médicaments dispensés à leurs patients ages, (2) une revue des problèmes médicamenteux existants et de ceux créés par de nouvelles ordonnances et (3) des conseils d'experts sur le choix d'un traitement médicamenteux. Le Canada est dans une position idéale pour devenir un pionnier dans le développement de tels systémes. Mais il faudrait d'abord mettre en place certaines politiques pour régler trois problèmes. Premièrement, l'information disponible sur les risques et les benefices des médicaments chez les aînés est inadequate car les personnes âgées «les plus malades» sont souvent excluses des essais cliniques. Les prérequis à l'approbation des medicaments doivent être amendés afin de permettre une évaluation satisfaisante des risques et des bénéfices des nouveaux medicaments chez les aînés. Deuxièmement, l'informatisation du système de santé est primordiale dans le développement d'outils informatiques d'aide à la décision pour la dispensation des soins. Les politiques futures devraient favoriser le developpement d'une infrastructure efficace si Ton veut faciliter la transition vers un système de santé informatisé et intégré. Troisièmement, les questions de nature éthiques et légales reliées à l'accés des données de consommation des médicaments via les réseaux informatiques doivent être identifiers. Des règies de conduite claires sur l'utilisation des nouvelles technologies doivent être développees.

Keywords

ElderlyPrescribingPhysician PracticeDrug-related IllnessAinésprescriptionpratique de la médecinemaladie liée aux medicaments
Type
Research Article
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 16 , Issue S1: Bridging Policy and Research on Aging/Tisser des liens entre les politiques et la recherche relative au vieillissement , Spring Printemps 1997 , pp. 147 - 161
Copyright
Copyright © Canadian Association on Gerontology 1997

Footnotes

*

This paper is a contribution of the Quebec Research Group on Medication Use in the Elderly (USAGE), funded by Health Canada's Seniors Independence Research Program.

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