Programme to improve the use of drugs in older people and involve general practitioners in community education

As part of a multi-pronged approach to improving the quality of drug use in the elderly, a pharmacist was contracted by the Division of General Practi ce (Northern Tasmania) to develop educational material and implement two ac ademic detailing sessions for general practitioners on the issues of advers e drug reactions and drug interactions in older people. The project aimed t o involve general practitioners in community education after optimizing rel evant therapeutic knowledge and standardizing prescribing practices. Sixtee n general practitioners were involved in the project and 13 of these agreed to participate in academic detailing. The pharmacist developed prescribing guidelines for general practitioners and discussed these and illustrative case studies at the academic detailing sessions. General practitioner-condu cted education sessions were completed by nine general practitioners to gro ups of carers, general practitioners, nurses and older people. Despite the relatively low numbers of general practitioners involved, the results of th e project were encouraging. Academic detailing by the pharmacist was well r eceived by the general practitioners, who indicated they would be willing t o participate in further sessions. Pre- and post-project multiple-choice te sts on therapeutic issues in the elderly indicated a strong trend for an in crease in knowledge. Analysis of general practitioners' patient records fou nd a statistically significant decline in the median numb er of medications prescribed per patient during the project. There was also a statistically significant decline in prescribing of 'indicator' medications, particularly psychoactive drugs and nonsteroidal antiinflammatory drugs in patients res ident in nursing homes. The project demonstrated that academic detailing by a pharmacist can be effective as part of a combined approach to improve th e quality of drug use in older people.