Clinical studyEffects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly☆
Section snippets
Study design and setting
The Geriatric Evaluation and Management Drug Study was a separately funded companion study to the parent Veterans Affairs (VA) Cooperative Study of geriatric evaluation and management that used a 2 × 2 factorial design to evaluate the effectiveness of inpatient or outpatient evaluation and management on mortality, health-related quality of life, functional status, and health care costs in frail elderly patients hospitalized in 11 VA Medical Centers (16). The Geriatric Evaluation and Management
Results
Of the 864 randomly selected patients, we received 845 study charts; 834 had complete data for evaluations. The characteristics of these 834 patients were similar to those of the 1388 patients enrolled in the VA Cooperative Study. From the 834 patients, we randomly sampled 400 for analyses of suboptimal prescribing. There were no significant differences in baseline characteristics between the two inpatient treatment groups in the adverse drug reaction sample (Table 1).
The most common adverse
Discussion
We found that specialized geriatric outpatient clinics, but not inpatient units, reduced the risk of serious adverse drug reactions in frail, hospitalized elderly patients. Specifically, between discharge and 12 months, patients receiving care from geriatric evaluation and management clinics had a 35% reduction in the risk of serious adverse drug reactions compared with usual outpatient care. This difference is larger than our previous outpatient clinical pharmacist intervention, which was
Acknowledgements
We gratefully acknowledge the valuable contributions of Ellen Tim, Pat Hartwell, Kate Raiford, Debra Pugh, Maria Horner, and Marc Huber for conduct of the study at the Durham VA GRECC and Aging Center, Duke Medical Centers; Mollie Scott, PharmD, Heather Hesselson, PharmD, Robert Maher, PharmD, Sean Jeffrey, PharmD, Rebecca Richard, PharmD, Tanya Knight, PharmD, Debbie Kennedy, PharmD, Kirsten Fanning, PharmD, and Talmahjia Sweat, PharmD, for their efforts with adverse event narratives,
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Financial support was provided by grant AG-15432 and the Veterans Affairs Cooperative Study Program 006. Additional support was provided by grant AG-14158 from the National Institute on Aging, Washington, D.C.; grant AI-51324 from the National Institute of Allergy and Infectious Diseases, Washington, D.C.; the VFW Endowed Chair in Pharmacotherapy for the Elderly, College of Pharmacy, University of Minnesota; and the Veterans Affairs Cooperative HSR&D Service.