SUMMARIES FOR PATIENTS

The Quality of Pharmacologic Care for Older Adults in Two Managed Care Organizations

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The summary below is from the full report titled "The Quality of Pharmacologic Care for Vulnerable Older Patients." It is in the 4 May 2004 issue of Annals of Internal Medicine (volume 140, pages 714-720). The authors are T. Higashi, P.G. Shekelle, D.H. Solomon, E.L. Knight, C. Roth, J.T. Chang, C.J. Kamberg, C.H. MacLean, R.T. Young, J. Adams, D.B. Reuben, J. Avorn, and N.S. Wenger.

What is the problem and what is known about it so far?

A growing proportion of Americans are older than 65 years of age and are at risk for functional decline. Decline may be due to health problems that lead to less independence in carrying out daily activities. High-quality medical care might help to prevent or postpone the functional decline that often accompanies aging. Pharmacologic care, the use of medications to treat health problems, is an important part of the care for older adults. However, little is known about the quality of pharmacologic care for older adults.

Why did the researchers do this particular study?

To evaluate the quality of pharmacologic care provided to patients older than 65 years of age who were at risk for functional decline.

Who was studied?

372 patients enrolled in 1 of 2 managed care organizations and whose interviews indicated a risk for functional decline or death. All patients were 65 years of age or older, spoke English, and lived in the community rather than in a nursing home or other institution.

How was the study done?

The researchers used quality indicators developed for the Assessing Care of Vulnerable Elders (ACOVE) project. Forty-three quality indicators addressed 4 aspects of pharmacologic care. First, did patients receive medications that were indicated for their medical conditions? Second, did patients receive medications that were likely to do more harm than good? Third, did patients receive appropriate education about their medications and was there appropriate documentation about these medications and communication with other doctors? Fourth, did patients receive appropriate monitoring while using the medications? The researchers reviewed patients' medical records and interviewed patients or their caregivers to obtain information about each of the quality indicators relevant to each patient. They then examined how often and in what types of situations care met the quality standards.

What did the researchers find?

Prescriptions for inappropriate medications (medications that were more likely to do harm than good) were infrequently given. Most quality problems related to failure to prescribe indicated medications; failure to monitor medications; and failure to provide medication along with proper documentation, education, and coordination with patients' other physicians.

What were the limitations of the study?

The results might not apply to other care settings. The study relied heavily on medical records, but these were not available or were incomplete for some patients.

What are the implications of the study?

Quality improvement efforts for older patients should focus on issues related to receipt of indicated medications, monitoring, patient education, and communications to patients' other doctors.