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Old 05-08-2009, 07:32 PM
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Default Prescription Training Puts Docs in Shoes of Older Patients

Two new studies show that specific training and tools can help young doctors do a better job of prescribing medications for their elderly patients.


Seniors face added challenges with prescriptions, especially since many tend to take multiple medications at one time. Avoiding their greater susceptibility to side effects and higher risk of drug interactions, and finding solutions to their possible physical, mental or financial impairments to maintaining dosing schedules were the focus of the studies, scheduled to be presented this week in Chicago at the American Geriatrics Society's Annual Scientific Meeting.

One study looked at a four-week program in "thoughtful prescribing" for elderly patients taught to internal medicine residents at Johns Hopkins Bayview Medical Center in Maryland. In addition to classroom learning, the students used special worksheets to review their patients' use of prescription and over-the-counter medicines.

"Although fundamentals of pharmacology are taught in medical school, it is during residency that one's prescribing practices are developed. Our hope is that by using a more deliberate approach to prescribing, we can teach doctors habits that result in more safe and sensible care for their vulnerable patients," report lead author Dr. Lynsey Brandt, of Johns Hopkins, said in an American Geriatrics Society news release.

The program resulted in nearly three-quarters of the residents learning their patients had been prescribed medicines that could interact with other medicines they were already on. In addition, about 22 percent learned their older patients had received at least one potentially inappropriate prescription medication.

"Our findings show that a brief, self-directed tool can be utilized to increase residents' awareness of important principles of prescribing," Brandt said.

The second study reviewed a Medical College of Wisconsin program about the elderly and polypharmacy -- the use of multiple drugs -- that had medical students and residents take complex regimens of candy "medications" for a week.

As a result of this hands-on experience, students learned about barriers elderly people may encounter when trying to maintain a dosing schedule, including the ailments of old age, such as arthritis, poor eyesight or memory, and psychological issues such as feeling one was taking too many medications and that meds weren't alleviating their ills. They discussed possible solutions to these issues -- including decreasing the number of medications, and utilizing friends and family to help keep the patient on their dosing schedules -- with each other and faculty members.

Questionnaires filled out before and after the program found that the participants believed they had become much more knowledgeable about the problems facing the elderly taking multiple medications, and that they would try to reduce the number and doses of prescriptions they give to seniors.

"Walking in their patient's shoes helps them think practically about changes both the physician and patient can make to decrease medications, and to help patients take their medications correctly," study lead author Dr. Kathryn Denson, said in a news release.
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