REDUCTION OF UNNECESSARY PRESCRIPTIONS IN OLDER ADULTS
Unnecessary drug prescribing without evidence base is a significant health problem. In particular, in the case of people over 65 years of age, polypharmacy and adverse effects can lead to negative consequences for people’s health and quality of life. On the other hand, improper prescriptions cause onerous costs to the health system, without any benefit for the patient, and consequently erode the ability of the financing system to pay for other beneficial treatments. Among the drugs inappropriately prescribed in the elderly population, there are various products used for the treatment of patients with mild cognitive impairment and dementia, including antioxidants, nootropic agents, vitamins, biological products and vasodilators ( Rojas et al., 2010; Rojas et al., 2013). Among these, the drug most used in Argentina for these purposes is nimodipine (Rojas et al., 2013). Nimodipine currently presents a single indication for the treatment of acute subarachnoid hemorrhages, which is usually performed in the period of hospitalization of the patient for short periods. It does not present evidence for the prevention or treatment of any condition associated with cognitive impairment on an outpatient and prolonged basis.
The planned intervention consisted of communicating with the physicians through e-mails to transmit: a) general information about the appropriate indications for psychotropic drugs in older adults according to scientific evidence (Condition of control: general information); b) Specific information based on evidence about the study drug (nimodipine) and about the participant’s prescriptive behavior compared to their peers (Active condition: specific information + feedback with social norm). The latter was the active intervention to be measured. The study was conducted between May and October 2019 and the results were published in 2020 in the medical journal JAMA Network Open (see Publications, below). The intervention produced a significant reduction in prescriptions at low cost, without coercive effects and through a procedure that is easily replicable and scalable to other populations and drugs.
The planned intervention consisted of communicating with the physicians through e-mails to transmit: a) general information about the appropriate indications for psychotropic drugs in older adults according to scientific evidence (Condition of control: general information); b) Specific information based on evidence about the study drug (nimodipine) and about the participant’s prescriptive behavior compared to their peers (Active condition: specific information + feedback with social norm). The latter was the active intervention to be measured. The study was conducted between May and October 2019 and the results were published in 2020 in the medical journal JAMA Network Open (see Publications, below). The intervention produced a significant reduction in prescriptions at low cost, without coercive effects and through a procedure that is easily replicable and scalable to other populations and drugs.