Background A drug prescription guide was written in order to promote appropriate drug prescription in the elderly and to reduce iatrogenic risk.
Purpose 2 years after its release, we wanted to assess the use of this guide by prescribers.
Materials and methods An audit was conducted before the prescription guide was released, then 2 years later. While checking the prescriptions for medicines in patients older than 75 years, we raised the following items: prescription of inappropriate drugs (according to the list of Laroche and al.), redundancies of treatment, inappropriate doses and regular monitoring of renal function or not. In this study we compared the results between the two audits (first audit versus two years later).
Results 25 prescriptions were analysed before the release of the guide and 30 prescriptions after. During the first audit, inappropriate drugs were identified in 40% of prescriptions (benzodiazepines (BZD), hypnotics and a stimulant laxative) against 43.3% two years later. The same therapeutic classes were involved, with in addition, a cerebral vasodilator, a central antihypertensive and a muscle relaxant in the second audit. None of the patients were taking non-steroidal anti-inflammatory drugs in either audit. 16% had a cerebral vasodilator versus 6.7% first time. Redundancies of treatment were observed for osmotic laxatives (28% vs. 10%), psychotropic drugs (68% vs. 36.7%) and BZD (4% vs. 16.7%). Unsuitable doses because of the age were found for 28% of patients vs. 10%, but also according to renal function during the second audit (6.7%). Monitoring of renal function was achieved in the previous year before audits in 100% vs. 93.3% of patients now.
Conclusions Despite the willingness of geriatricians to simplify drug prescriptions, inappropriate treatments have increased as well as BZD redundancies and inappropriate doses related to renal function appearing. These results were made available to geriatricians. The use of pharmaceutical checks on all geriatric prescriptions will assist doctors in this work. A working group of pharmacists/geriatricians has been created in order to supplement this guide with a specific geriatric therapeutic booklet, suggesting possible substitutions for all inappropriate drugs.
No conflict of interest.
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