Takahiro Higashi, MD; Paul G. Shekelle, MD, PhD; David H. Solomon, MD; Eric L. Knight, MD, MPH; Carol Roth, RN, MPH; John T. Chang, MD, MPH; Caren J. Kamberg, MSPH; Catherine H. MacLean, MD, PhD; Roy T. Young, MD; John Adams, PhD; David B. Reuben, MD; Jerry Avorn, MD; Neil S. Wenger, MD, MPH
Acknowledgments: The authors thank Robert Brook, MD, ScD, for his guidance and Patricia Smith and Victor Gonzalez for technical assistance.
Grant Support: By a contract from Pfizer Inc. to RAND. Dr. Shekelle is a Senior Research Associate of the Veterans Affairs Health Services Research and Development Service. Dr. Chang is supported by a National Research Service Award (PE-19001) and the University of California, Los Angeles, Specialty Training and Advanced Research (STAR) Program.
Potential Financial Conflicts of Interest:Stock ownership or options (other than mutual funds): Roy T. Young (Pfizer Inc.); Grants received: J. Avorn (Pfizer Inc., Bristol-Myers Squibb, Novo Nordisk, Pharmacia).
Requests for Single Reprints: Takahiro Higashi, MD, Division of General Internal Medicine, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095.
Current Author Addresses: Drs. Higashi and Chang: Division of General Internal Medicine, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095-1736.
Dr. Shekelle: Greater Los Angeles Veterans Affairs Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Drs. Solomon, MacLean, Adams, and Wenger and Ms. Roth: RAND, 1700 Main Street, M-26, Santa Monica, CA 90407-2138.
Drs. Knight and Avorn: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 341, Boston, MA 02115.
Ms. Kamberg: RAND, 1200 South Hayes Street, Arlington, VA 22202.
Dr. Young: Division of General Internal Medicine, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.
Dr. Reuben: Division of Geriatrics, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.
Higashi T., Shekelle P., Solomon D., Knight E., Roth C., Chang J., Kamberg C., MacLean C., Young R., Adams J., Reuben D., Avorn J., Wenger N.; The Quality of Pharmacologic Care for Vulnerable Older Patients. Ann Intern Med. 2004;140:714-720. doi: 10.7326/0003-4819-140-9-200405040-00011
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Published: Ann Intern Med. 2004;140(9):714-720.
Prescription and management of medications are important issues for older adults.
Among elders enrolled in two managed care organizations, most quality problems were related to failure to prescribe indicated medications; failure to monitor medications; and failure to provide medication along with proper documentation and education in concert with other physicians.
Prescribing inappropriate medications for older adults is less of an issue than other aspects of drug therapy. Quality improvement efforts should focus on avoiding errors of omission in prescribing indicated medications, monitoring, patient education, and follow-up.
Pharmacotherapy is an essential component of medical treatment for older patients, but medications are also responsible for many adverse events in this group. Ninety percent of people 65 years of age or older take at least one medication (1). This age group, which represents only 13% of the population, accounts for one third of all prescription drug expenditures in the United States (2). Many older persons take multiple drugs for the treatment of several conditions, which increases the chance of adverse drug reactions, drug–drug interactions, and drug–disease interactions. The frequency of adverse drug events in elderly outpatients ranges from 10% to 35%, depending on the setting (3-5). Recognizing the magnitude of medication-related issues, panels of geriatric experts rate medication problems among the most important quality-of-care problems for older patients (6-8).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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