Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T09:47:42.605Z Has data issue: false hasContentIssue false

Inappropriate prescribing in older people

Published online by Cambridge University Press:  01 February 2008

Paul Gallagher*
Affiliation:
Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
Denis O'Mahony
Affiliation:
Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
*
Address for correspondence: Paul Gallagher, Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.

Extract

Optimal prescribing is critical to the goals of geriatric medicine of curing disease, eliminating or reducing symptoms, and improving functioning. However, prescribing decisions in older people are often complex. There is marked heterogeneity in health status and functional capacity amongst older people, who range from fit, active, independent individuals to those who are physically and mentally frail, with limited physiological reserve. Age-related changes in physiology affect drug pharmacokinetics and pharmacodynamics, and together with various pathological processes, increase the risk of adverse drug events (ADEs). This risk is heightened by prescription of multiple medications to treat multiple co-morbidities. Consequently, balancing safety and quality of prescribing for older people with appropriate treatment of all co-morbidities can be challenging.

Type
Psychological and social gerontology
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Epstein, AM, Hall, JA, Besdine, R et al. The emergence of geriatric assessment units. Ann Intern Med 1987; 106:299303.CrossRefGoogle ScholarPubMed
2Nelson, EA, Dannefer, D. Aged heterogeneity: fact or fiction? The fate of diversity in gerontological research. Gerontologist 1992; 32:1723.CrossRefGoogle ScholarPubMed
3Woodhouse, KW, O'Mahony, MS. Frailty and ageing. Age Ageing 1997; 26:245–46.CrossRefGoogle ScholarPubMed
4Mangoni, AA, Jackson, SH. Age-related changes in pharamcokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004; 57:614.CrossRefGoogle Scholar
5Lazarou, J, Pomeranz, BH, Corey, PN. Incidence of adverse drug reactions in hospitalised patients: a meta-analysis of prospective studies. JAMA 1998; 279:1200–05.CrossRefGoogle ScholarPubMed
6Woodhouse, KW, Ewynne, HA. Age-related changes in liver size and hepatic blood flow: the influence of drug metabolism in the elderly. Clin Pharacokinet 1988; 15:328–44.Google ScholarPubMed
7Hunt, CM, Westerkam, WR, Stave, GM et al. Hepatic cytochrome P-4503A (CYP3A) activity in the elderly. Mech Ageing Dev 1992; 64:189.CrossRefGoogle ScholarPubMed
8Hunt, CM, Westerkam, WR, Stave, GM. Effect of age and gender on the activity of human hepatic CYP3A. Biochem Pharmacol 1992; 44: 275.CrossRefGoogle ScholarPubMed
9Gage, BF, Fihn, SD, White, RH. Management and dosing of warfarin therapy. Am J Med 2000; 109:481.CrossRefGoogle ScholarPubMed
10Swift, CG, Ewen, JM, Clarke, P, Stephenson, IH. Responsiveness to oral diazepam in the elderly: relationship to total and free plasma concentrations. Br J Clin Pharmacol 1985; 20:111–18.CrossRefGoogle ScholarPubMed
11Maixner, SM, Mellow, AM, Tandon, R. The efficacy, safety and tolerability of antipsychotics in the elderly. J Clin Psychiatry 1999; 60:2941.Google ScholarPubMed
12Christchilles, EA, Foley, DJ, Wallace, RB et al. Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly. J Gerontol 1992; 47:137–44.CrossRefGoogle Scholar
13Arnett, RH 3rd, Blank, LA, Brown, AP et al. National Health Expenditures 1988. Office of National Cost Estimates. Health Care Finance Rev 1990; 11:141.Google ScholarPubMed
14Gupta, S, Rappaport, HM, Bennett, LT. Inappropriate drug-prescribing and related outcomes for elderly Medicaid beneficiaries residing in nursing homes. Clin Ther 1996; 18:183–96.CrossRefGoogle ScholarPubMed
15Golden, AG, Preston, RA, Barnett, SD et al. Inappropriate prescribing in homebound older adults. J Am Geriatr Soc 1999; 47:948–53.CrossRefGoogle ScholarPubMed
16O'Connor, K, O'Mahony, D. Drugs and ageing. In: Liston, R, Mulkerrin, EC eds. Medicine for older patients: cases and practice. Dublin: Eireann Healthcare Publications; 2003: 205.Google Scholar
17Kennerfalk, A, Ruigomex, A, Wallander, MA, Wilhelmsen, L, Johansson, S. Geriatric drug therapy and healthcare utilization in the United Kingdom. Ann Pharmacother 2002; 36:797803.CrossRefGoogle ScholarPubMed
18Everitt, DE, Avorn, J. Drug prescribing for the elderly. Arch Intern Med 1986; 146:2393–96.CrossRefGoogle ScholarPubMed
19Kaufman, DW, Kelly, JP, Rosenberg, L et al. Recent patterns of medication use in the ambulatory adult population of the United States: The Slone Survey. JAMA 2002; 287: 337.CrossRefGoogle ScholarPubMed
20Broderick, E. Prescribing patterns for nursing-home residents in the US: the reality and the vision. Drugs Aging 1997; 11:255–60.CrossRefGoogle ScholarPubMed
21Onder, G, Pedone, C, Landi, F et al. Adverse drug reactions as a cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 2002; 50:1962.CrossRefGoogle ScholarPubMed
22Juurlink, DN, Mamdami, M, Kopp, A et al. Drug-drug interactions among elderly patients hospitalised for drug toxicity. JAMA 2003; 289:1652.CrossRefGoogle ScholarPubMed
23Larson, EB, Kukall, WA, Buchner, D et al. Adverse drug reactions associated with global cognitive impairment in older persons. Ann Intern Med 1987; 107:169–73.CrossRefGoogle Scholar
24Inouye, SK, Charpentier, PA. Precipitating factors for delirium in hospitalised elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275:852–57.CrossRefGoogle ScholarPubMed
25Hanlon, JT, Cutson, T, Ruby, CM. Drug-related falls in the elderly. Topics Geriatr Rehabil 1996; 11:3854.CrossRefGoogle Scholar
26Jacqmin-Gadda, H, Fourrier, A, Commenges, D et al. Risk factors for fractures in the elderly. Epidemiol 1998; 9:417–23.CrossRefGoogle ScholarPubMed
27Hogan, DB. Revisiting the O complex: urinary incontinence, delirium and polypharmacy in elderly patients. Can Med Assoc J 1997; 157:1071–77.Google ScholarPubMed
28Goldberg, RM, Mabee, J, Chan, L, Wong, S. Drug-drug and drug-disease interactions in the emergency department: analysis of a high-risk population. Am J Emerg Med 1996; 14:447–50.CrossRefGoogle ScholarPubMed
29Montamat, SC, Cusack, B. Overcoming problems with polypharmacy and drug misuse. Clin Geriatr Med 1992; 8:143–58.CrossRefGoogle ScholarPubMed
30Lipton, HL, Bero, LA, Bird, JA et al. The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing: a randomised controlled trial. Med Care 1992; 30:646–58.CrossRefGoogle Scholar
31Schmader, K, Hanlon, JT, Weinberger, M et al. Appropriateness of medication prescribing in ambulatory elderly patients. J Am Geriatr Soc 1994; 42:1241–47.Google ScholarPubMed
32Rochon, PA, Gurwitz, JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997; 315:1096–69.CrossRefGoogle ScholarPubMed
33Col, N, Fanale, JE, Kronholm, P. The role of medication non-compliance and adverse drug reactions in hospitalisations of the elderly. Arch Intern Med 1990; 150:841–45.CrossRefGoogle ScholarPubMed
34Grymonpre, RE, Mitenko, PA, Sitar, DS et al. Drug-associated hospital admissions in older medical patients. J Am Geriatr Soc 1988; 36:1092–98.CrossRefGoogle ScholarPubMed
35Rochon, PA, Gurwitz, JH. Prescribing for seniors: neither too much nor too little. JAMA 1999; 12:95108.Google Scholar
36Berlowitz, DR, Ash, AS, Hickey, EC et al. Inadequate management of blood pressure in a hypertensive population. N Eng J Med 1998; 339:1957–63.CrossRefGoogle Scholar
37NIH Consensus Conference. Diagnosis and treatment of depression in late life. JAMA 1992; 268:1018–24.CrossRefGoogle Scholar
38Batty, GM, Grant, RL, Aggarwal, R et al. Using prescribing indicators to measure the quality of prescribing to elderly medical inpatients. Age Ageing 2003; 32:292–98.CrossRefGoogle Scholar
39Mendelson, G, Aranow, WS. Underutilization of angiotensin-converting enzyme inhibitors in older patients with Q-wave anterior myocardial infarction in an academic hospital-based geriatrics practice. J Am Geriatr Soc 1998; 46:751–52.CrossRefGoogle Scholar
40Chin, MH, Wang, JC, Zgang, JX et al. Utilization and dosing of angiotensin-converting enzyme inhibitors for heart failure: effect on physician specialty and patient characteristics. J Gen Intern Med 1997; 12:563–66.CrossRefGoogle ScholarPubMed
41Mendelson, G, Aranow, WS. Underutilization of warfarin in older persons with chronic nonvalvular atrial fibrillation at risk for developing stroke. J Am Geriatr Soc 1998; 46:1423–24.CrossRefGoogle ScholarPubMed
42Ganz, DA, Lamas, GA, Orav, EJ et al. Age-related differences in management of heart disease: a study of cardiac medication use in an older cohort. J Am Geriatr Soc 1999; 47:145–50.CrossRefGoogle Scholar
43Hanlon, JT, Schmader, KE, Kornkowski, MJ et al. Adverse drug events in high-risk older outpatients. J Am Geriatr Soc 1997; 45:945–48.CrossRefGoogle ScholarPubMed
44Johnson, JA, Bootman, JL. Drug-related morbidity and mortality and the economic impact of pharmaceutical care. Am J Health Syst Pharm 1997; 54:554–58.CrossRefGoogle ScholarPubMed
45Beard, K. Adverse drug reactions as a cause of hospital admissions in the aged. Drugs Aging 1992; 2:356–67.CrossRefGoogle ScholarPubMed
46Gurwitz, JH, Field, TS, Avorn, J et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med 2000; 209:8794CrossRefGoogle Scholar
47Lindley, CM, Tully, MP, Paramsothy, V et al. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing 1992; 21:294300.CrossRefGoogle Scholar
48Klarin, I, Wimo, A, Fastbom, J. The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging 2005; 22:6982.CrossRefGoogle ScholarPubMed
49Spinewine, A, Schmader, KE, Barber, N et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007; 370:173–84.CrossRefGoogle ScholarPubMed
50Hanlon, JT, Schmader, KE, Ruby, CM, Weinberger, M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 2001; 49:200–09.CrossRefGoogle ScholarPubMed
51Simonson, W, Feinberg, JL. Medication-related problems in the elderly: defining the issues and identifying solutions. Drugs Aging 2005; 22:559–69.CrossRefGoogle ScholarPubMed
52Cribb, A, Barber, N. Prescribers, patients and policy: the limits of technique. Health Care Anal 1997; 5:292–98.CrossRefGoogle ScholarPubMed
53Buetow, SA, Sibbald, B, Cantrill, JA, Halliwell, S. Appropriateness in health care: application to prescribing. Soc Sci Med 1997; 45:261–71.CrossRefGoogle ScholarPubMed
54Beers, MH, Ouslander, JG, Rollingher, I et al. Explicit criteria for determining inappropriate medication use in nursing-home residents. Arch Intern Med 1991; 151:1825–32.CrossRefGoogle ScholarPubMed
55Beers, MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997; 157:1531–36.CrossRefGoogle ScholarPubMed
56Fick, DM, Cooper, JW, Wade, W et al. Updating the Beers' Criteria for Potentially Inappropriate Medication Use in Older Adults – Results of a US Consensus Panel of Experts. Arch Intern Med 2003; 163:2716–24.CrossRefGoogle ScholarPubMed
57McLeod, PJ, Huang, AR, Tamblyn, RN, Gayton, DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997; 156:385–91.Google ScholarPubMed
58Naugler, CT, Brymer, C, Stolee, P, Arcese, ZA. Development and validation of an improved prescribing for the elderly tool. Can J Clin Pharmacol 2000; 7:103–07.Google ScholarPubMed
59Laroche, ML, Charmes, JP, Merle, L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmaol 2007; 63:725–31.CrossRefGoogle ScholarPubMed
60Gallagher, P, Ryan, C, Byrne, S, Kennedy, J, O'Mahony, D. STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment): consensus validation. Int J Clin Pharm Ther 2008; 46:7283.CrossRefGoogle ScholarPubMed
61Wenger, NS, Shekelle, PG. Assessing care of vulnerable elders: ACOVE project overview. Ann Intern Med 2001; 135:642–46.CrossRefGoogle ScholarPubMed
62Oborne, CA, Hooper, R, Swift, CG, Jackson SHD. Explicit, evidence-based criteria to assess the quality of prescribing to elderly nursing-home residents Age Ageing 2003; 32:102–08.CrossRefGoogle ScholarPubMed
63Hanlon, JT, Schmader, KE, Samsa, GP et al. A method for assessing drug-therapy appropriateness. J Clin Epidemiol 1992; 45:1045–51.CrossRefGoogle ScholarPubMed
64Jeffrey, S, Ruby, CM, Hanlon, JT et al. The impact of an interdisciplinary team on suboptimal prescribing in a long-term care facility. Consult Pharm 1999; 14:1386–89.Google Scholar
65Pitkala, KH, Strandberg, TE, Tilvis, RS. Inappropriate drug prescribing in home-dwelling elderly patients: a population based survey. Arch Intern Med. 2002; 162:1707–12.CrossRefGoogle ScholarPubMed
66O'Donnell, MJ, Hankey, GJ, Eikelboom, JW. Antiplatelet therapy for secondary prevention of non-cardioembolic ischaemic stroke: a critical review. Stroke 2008; 39:1638–46.CrossRefGoogle Scholar
67Liu, GG, Chritensen, DB. The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc 2002; 42:847–57.Google ScholarPubMed
68van der Hooft, CS, ‘t Jong, GW, Dieleman, JP et al. Inappropriate drug prescribing in older adults: the updated 2002 Beers' criteria – a population-based cohort study. Br J Clin Pharmacol; 2005; 60:137–44.CrossRefGoogle ScholarPubMed
69Barry, PJ, O'Keefe, N, O'Connor, KA, O'Mahony, D. Inappropriate prescribing in the elderly: a comparison of the Beers' criteria and the Improved Prescribing in the Elderly Tool (IPET) in acutely ill elderly hospitalised patients. J Clin Pharm Ther 2006; 31:617–26.CrossRefGoogle Scholar
70Gallagher, P, Barry, P, Ryan, C, Hartigan, I, O'Mahony, D. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' criteria. Age Ageing 2008; 37:96101CrossRefGoogle Scholar
71Fialova, D, Topinkova, E, Gambassi, G et al. Potentially inappropriate medication-use among elderly home-care patients in Europe. JAMA 2005; 293:1348–58.CrossRefGoogle ScholarPubMed
72Gallagher, P, O'Mahony, D. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): Comparison with Beers' Criteria. Age Ageing 2008 (in press).CrossRefGoogle Scholar
73Barry, P, Gallagher, P, Ryan, C, O'Mahony, D. START Screening Tool to Alert Doctors to Right Treatment. An evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing 2007; 36:628–31.CrossRefGoogle ScholarPubMed
74Higashi, T, Shekelle, PG, Soloman, DH. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med 2004; 140:714–20.CrossRefGoogle ScholarPubMed
75Higashi, T, Shekelle, PG, Adams, JL et al. Quality of care is associated with survival in vulnerable older patients. Ann Intern Med 2005; 143:274–81.CrossRefGoogle ScholarPubMed
76Samsa, GP, Hanlon, JT, Schmader, KE et al. A summated score for the Medication-Appropriateness Index: development and assessment of clinimetric properties, including content validity. J Clin Epidemiol 1994; 47:891–96.CrossRefGoogle ScholarPubMed
77Hajjar, ER, Janoln, JT, Sloane, RJ et al. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc 2005; 53:1518–23.CrossRefGoogle ScholarPubMed
78Fitzgerald, LS, Hanlon, JT, Shelton, PS et al. Reliability of a modified Medication-Appropriateness Index in ambulatory older persons. Ann Pharmacother 1997; 31:543–48.CrossRefGoogle ScholarPubMed
79Pronovost, PJ, Nolan, T, Zeger, S, Miller, M, Rubin, H. How can clinicians measure safety and quality in acute care? Lancet 2004; 363:1061–67.CrossRefGoogle ScholarPubMed
80Laroche, ML, Charmes, JP, Nouaille, Y, Picard, B, Merle, L. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 2007; 63:177–86.CrossRefGoogle Scholar
81Rask, KJ, Wells, KJ, Teitel, GS, Hawley, JN, Richards, C, Gazmararian, JA. Can an algorithm for inappropriate prescribing predict adverse drug events? Am J Manag Care 2005; 11:145–51.Google Scholar
82Page, RL, Ruskin, JM. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. Am J Geriatr Pharmacother 2006; 4:297305.CrossRefGoogle ScholarPubMed
83Budnitz, DS, Shehab, N, Kegler, SR et al. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147:755–65.CrossRefGoogle ScholarPubMed
84Fu, AZ, Liu, GG, Christensen, DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 2004; 52:1934–39.CrossRefGoogle ScholarPubMed
85Franic, DM, Jiang, JZ. Potentially inappropriate drug-use and health-related quality of life in the elderly. Pharmacotherapy 2006; 26:768–78.CrossRefGoogle ScholarPubMed
86Schmader, KE, Hanlon, JT, Landsman, PB, Samsa, GP, Lewis, IK, Weinberger, M. Inappropriate prescribing and health outcomes in elderly veteran outpatients. Ann Pharmacother 1997; 31:529–33CrossRefGoogle ScholarPubMed
87Lau, DT, Kasper, JD, Potter, DE, Lyles, A, Bennett, RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing-home residents. Arch Intern Med 2005; 165:6874.CrossRefGoogle ScholarPubMed
88Perri, M III, Menon, AM, Deshpande, AD et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005; 39:405–11.CrossRefGoogle ScholarPubMed
89Fick, DM, Waller, JL, Maclean, JR et al. Potentially inappropriate medication use in a Medicare managed-care population: association with higher costs and utilization. J Manag Care Pharm 2001; 7:407–13.Google Scholar
90Ravio, MM, Laurila, JV, Strandberg, TE, Tilvis, RS, Pitkala, KH. Use of inappropriate medications and their prognostic significance among in-hospital and nursing-home patients with and without dementia in Finland. Drugs Aging 2006; 23:333–43.CrossRefGoogle Scholar
91Aparasu, RR, Mort, JR. Prevalence, correlates, and associated outcomes of potentially inappropriate psychotropic use in community-dwelling elderly. Am J Geriatr Pharmacother 2004; 2:102–11.CrossRefGoogle ScholarPubMed
92Onder, G, Landi, F, Liperoti, R, Fiavola, D, Gambassi, G, Bernabei, R. Impact of inappropriate drug use among hospitalised older adults. Eur J Clin Pharmacol 2005; 61:453–59.CrossRefGoogle Scholar
93Zuckerman, IH, Langenberg, P, Baumgarten, M et al. Inappropriate drug use and risk of transition to nursing homes among community-dwelling older adults. Med Care 2006; 44:722–30.CrossRefGoogle ScholarPubMed
94Hanlon, JT, Fillenbaum, GG, Kuchibhatla, M et al. Impact of inappropriate drug use on mortality and functional status in representative community-dwelling elders. Med Care 2002; 40:166–76.CrossRefGoogle ScholarPubMed
95Masoudi, FA, Rathore, SS, Wang, Y et al. National patterns of use and effectiveness of angiotensin-converting enzyme inhibitors in older patients with heart failure and left-ventricular systolic dysfunction. Circulation 2004; 110:724–31.CrossRefGoogle ScholarPubMed
96Soumerai, SB, McLaughlin, TJ, Spiegleman, D et al. Adverse outcomes of under-use of beta-blockers in older survivors of acute myocardial infarction. JAMA 1997; 277:115–21.CrossRefGoogle Scholar
97Havranek, EP, Abrams, F, Stevens, E et al. Determinants of mortality in elderly patients with heart failure: the role of angiotensin-converting enzyme inhibitors. Arch Intern Med 1998; 158:2024–28.CrossRefGoogle ScholarPubMed
98Tamblyn, R, Laprise, R, Hanley, JA et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 2001; 285:421–29.CrossRefGoogle ScholarPubMed
99Heisler, M, Langa, KM, Eby, EL, Fendrick, AM, Kabeto, MU, Piette, JD. The health effects of restricting prescription medication use because of cost. Med Care 2004; 42:2129.CrossRefGoogle ScholarPubMed
100Soumerai, SB, Ross-Degnan, D, Avorn, J et al. Effects of Medicaid drug-payment limits on admission to hospital and nursing homes. N Engl J Med 1991; 325:1072–77.CrossRefGoogle ScholarPubMed
101Schmader, KE, Hanlon, JT, Pieper, CF et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 2004; 116:394401.CrossRefGoogle ScholarPubMed
102Saltvedt, I, Spigset, O, Ruths, S, Fayers, P, Kaasa, S, Sletvold, O. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomized study. Eur J Clin Pharmacol 2005; 61:921–28.CrossRefGoogle Scholar
103Crotty, M, Halbert, J, Rowett, D et al. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age Ageing 2004; 33:612–17.CrossRefGoogle Scholar
104Stranberg, TE, Pitkala, KH, Berglind, S, Nieminen, MS, Tilvis, RS. Multifactorial intervention to prevent recurrent cardiovascular events in patients 75 years or older: the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) Study: randomised, controlled trial. Am Heart J 2006; 152:585–92.CrossRefGoogle Scholar
105Hanlon, JT, Weinberger, M, Samsa, GP et al. A randomised, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 1996; 100:428–37.CrossRefGoogle ScholarPubMed
106Crotty, M, Rowett, D, Spurling, L, Giles, LC, Phillips, PA. Does the addition of a pharmacist transition-coordinator improve evidence-based medication-management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomised controlled trial. Am J Geriatr Pharmacother 2004; 2:257–64.CrossRefGoogle Scholar
107Spinewine, A, Swine, C, Dhillon, S et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomised controlled trial. J Am Geriatr Soc 2007; 55:658–65.CrossRefGoogle Scholar
108Tamblyn, R, Huang, A, Perreault, R et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003; 169:549–56.Google ScholarPubMed
109Pimlott, NJ, Hux, JE, Wilson, LM, Kahan, M, Li, C, Rosser, WW. Educating physicians to reduce benzodiazepine use by elderly patients: a randomised controlled trial. CMAJ 2003; 168:835–39.Google Scholar