Database Monitors Geriatric Prescriptions

Using a computer database to flag prescriptions potentially harmful to older folks can persuade their doctors to try an alternative considered safer, according to the country’s largest pharmacy benefit manager.

Merck-Medco Managed Care, a subsidiary of pharmaceutical giant Merck & Co., said such changes can help prevent nasty--and costly--side effects that often result in hospitalizations or dizziness causing falls and broken bones. Occasionally, medication errors cause death.

“Among the elderly, 17% of hospitalizations are due to a medication misadventure,” and those hospital stays cost as much as $10 billion annually, said Dr. Mark Monane, senior director of geriatrics for Merck-Medco.

The company, which processes pharmacy claims or directly mails medications to one in five Americans, including 10 million over age 65, in 1995 began its Partners for Healthy Aging program. Its aim is to reduce adverse drug reactions caused by prescribing the wrong drug or the wrong dosage to senior citizens.

“The older population is growing rapidly, and it is not unusual for older people to be taking several medications,” Monane said in a telephone interview after presenting his study, the largest to date, last month at the National Managed Health Care Congress meeting on Medicare and Medicaid in Washington.

As people age, he said, the way their body breaks down medications and how quickly it excretes them changes, “so a drug that was good for them at 40 no longer is at 60 or 70.”

Meanwhile, few pharmacists and physicians have specialized training in geriatric medicine, and even pharmacists find it difficult to know every possible side effect or interaction a drug could have. In addition, an elderly patient’s primary doctor may not be familiar with drugs prescribed by a specialist.

So Merck-Medco compiled the best research on geriatric medicine and, with a panel of experts, developed a database focusing on 11 types of medications commonly used by seniors. The system automatically alerts a pharmacist at one of the company’s 13 mail service facilities, and the pharmacist then calls the prescribing physician to point out the drug’s dangers and suggest alternatives.

To determine whether the system is preventing patients from receiving the potentially dangerous drug, Merck-Medco examined a nationwide sample of 23,269 patients whose prescriptions triggered a total of 43,007 alerts from April 1996 through March 1997.

In 24% of 24,266 cases, where pharmacists were able to discuss the prescription with the physician, he or she then opted for a different medication, another dosage or some other strategy, such as a dietary change. Most of the alerts and medication changes involved antidepressants such as Elavil and tranquilizers such as Valium.

“This is something that obviously there’s a need for,” said Michael Donio of the People’s Medical Society in Allentown, Pa. “We know that when drug manufacturers set a dosage . . . it doesn’t take into account that someone might be 78 or down to 100 pounds.”

Some individual and chain pharmacies have such warning systems, but at others the computer system merely determines the price, prints the label and tracks inventory.

Hedy Cohen, vice president of nursing at the Institute for Safe Medication Practices in Warminster, Pa., said raw data from a survey it is conducting among U.S. hospital pharmacies so far show that “hospitals have not been able to adequately adapt warnings into their computer systems.”