Physician acceptance rate of pharmacist recommendations to reduce use of potentially inappropriate medications in the assisted living setting.

OBJECTIVE To reduce the number of potentially inappropriate medication orders, based on the Beers' criteria, for an elderly population residing in assisted living facilities through consultant pharmacist medication review, interventions, and recommendations DESIGN Prospective case series of consultant pharmacist recommendations. PATIENTS Census of 456 residents of assisted living facilities who received a new or refill medication order during the preceding two months. INTERVENTIONS Potentially inappropriate medications for the elderly were identified and recommendation letters faxed to the physician for consideration. MAIN OUTCOME MEASURES Demographic characteristics, prevalence data for medications ordered and considered potentially inappropriate based on the Beers' criteria, and physician acceptance and return rate of recommendations. RESULTS The data demonstrated that 31.6% of the residents in this study were receiving one or more routine or p.r.n. medications orders considered potentially inappropriate based on the Beers' criteria. The majority (82.9%) of the residents were female, and the average age of the residents was 85.4 +/- 7.34 SD years (range, 66-102 years). A total of 205 routine and p.r.n. medication orders were identified as potentially inappropriate. Of these orders, 16.7% were discontinued and 2.5% were changed to lower dosage regimens. The overall return rate of all recommendations faxed to physicians was 88.7%. CONCLUSIONS Potentially inappropriate medications, according to the Beers' criteria for use in the elderly, are ordered at a high rate for residents of assisted living facilities. Though not mandated in all states, screening of these orders by a consultant pharmacist, with recommendations for alternative pharmacotherapy of less risk, would be appropriate. Physicians do address the recommendations in the majority of cases, but the physician acceptance rate of those recommendations is much lower. Consultant pharmacists have the opportunity to educate physicians of the risks of using medications considered potentially inappropriate for geriatric patients. Further studies are needed to determine barriers to physician acceptance of these recommendations.