***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVES To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning . DESIGN A r and omized-controlled trial . SETTING Health center ambulatory clinic . PARTICIPANTS Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks . A  medication-change intervention group of 57 elders was compared with a control group of 76 elder adults . INTERVENTION The primary intervention was a comprehensive review and recommended modification of a patient 's medication regimen . Changes were endorsed by each patient 's primary physician and discussed with each patient . MEASUREMENTS Measures were the Timed Manual Performance Test , Physical Performance Test , Functional Reach Assessment , subtests from the Wechsler Adult Intelligence Scale , a modified R and t Memory Test , the Center for Epidemiological Studies -Depression Scale , the Self-Rating Anxiety Scale , and the R and 36-item Health Survey 1.0 . Comorbidity was determined using the International Classification of Diseases , Ninth Revision , Clinical Modification . Medication usage was determined using brown bag review . RESULTS Intervention subjects decreased their medications by an average of 1.5 drugs . No differences in functioning were observed between groups . Intervention subjects saved an average $ 26.92 per month in wholesale medication costs ; control subjects saved $ 6.75 per month ( P<.006 ) . CONCLUSION Although the intervention significantly reduced the medications taken and monthly cost , most patients were resistant to reducing medications to the recommended level . Further study is needed to underst and patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health . Greater focus on prescriber behavior is recommended BACKGROUND Although computerized physician order entry reduces medication errors among in patients , little is known about the use of this system in primary care . METHODS We calculated the override rate among 3481 consecutive alerts generated at 5 adult primary care practice s that use a common computerized physician order entry system for prescription writing . For detailed review , we selected a r and om sample of 67 alerts in which physicians did not prescribe an alerted medication and 122 alerts that result ed in a written prescription . We identified factors associated with the physicians ' decisions to override a medication alert , and determined whether an adverse drug event ( ADE ) occurred . RESULTS Physicians overrode 91.2 % of drug allergy and 89.4 % of high-severity drug interaction alerts . In the multivariable analysis using the medical chart review sample ( n = 189 ) , physicians were less likely to prescribe an alerted medication if the prescriber was a house officer ( odds ratio [ OR ] , 0.26 ; 95 % confidence interval [ CI ] , 0.08 - 0.84 ) and if the patient had many drug allergies ( OR , 0.70 ; 95 % CI , 0.53 - 0.93 ) . They were more likely to override alerts for renewals compared with new prescriptions ( OR , 17.74 ; 95 % CI , 5.60 - 56.18 ) . We found no ADEs in cases where physicians observed the alert and 3 ADEs among patients with alert overrides , a nonsignificant difference ( P = .55 ) . Physician review ers judged that 36.5 % of the alerts were inappropriate . CONCLUSIONS Few physicians changed their prescription in response to a drug allergy or interaction alert , and there were few ADEs , suggesting that the threshold for alerting was set too low . Computerized physician order entry systems should suppress alerts for renewals of medication combinations that patients currently tolerate CONTEXT Adverse drug events ( ADEs ) are a significant and costly cause of injury during hospitalization . OBJECTIVES To evaluate the efficacy of 2 interventions for preventing nonintercepted serious medication errors , defined as those that either result ed in or had potential to result in an ADE and were not intercepted before reaching the patient . DESIGN Before-after comparison between phase 1 ( baseline ) and phase 2 ( after intervention was implemented ) and , within phase 2 , a r and omized comparison between physician computer order entry ( POE ) and the combination of POE plus a team intervention . SETTING Large tertiary care hospital . PARTICIPANTS For the comparison of phase 1 and 2 , all patients admitted to a stratified r and om sample of 6 medical and surgical units in a tertiary care hospital over a 6-month period , and for the r and omized comparison during phase 2 , all patients admitted to the same units and 2 r and omly selected additional units over a subsequent 9-month period . INTERVENTIONS A physician computer order entry system ( POE ) for all units and a team-based intervention that included changing the role of pharmacists , implemented for half the units . MAIN OUTCOME MEASURE Nonintercepted serious medication errors . RESULTS Comparing identical units between phases 1 and 2 , nonintercepted serious medication errors decreased 55 % , from 10.7 events per 1000 patient-days to 4.86 events per 1000 ( P=.01 ) . The decline occurred for all stages of the medication-use process . Preventable ADEs declined 17 % from 4.69 to 3.88 ( P=.37 ) , while nonintercepted potential ADEs declined 84 % from 5.99 to 0.98 per 1000 patient-days ( P=.002 ) . When POE-only was compared with the POE plus team intervention combined , the team intervention conferred no additional benefit over POE . CONCLUSIONS Physician computer order entry decreased the rate of nonintercepted serious medication errors by more than half , although this decrease was larger for potential ADEs than for errors that actually result ed in an ADE OBJECTIVE To determine if a visual intervention ( medication grid ) delivered to physicians can reduce medication regimen complexity . DESIGN Nonr and omized , controlled trial . SETTING Veterans Affairs medical center . PATIENTS / PARTICIPANTS Eight hundred thirty-six patients taking at least 5 medications at the time of admission and the 48 teams of physicians and students on the general medicine inpatient service . INTERVENTION For intervention patients , a medication grid was created that displayed all of the patients ' medicines and the times of administration for 1 week . This grid was delivered to the admitting resident soon after admission . MEASUREMENTS AND MAIN RESULTS For the patients of each team of physicians , we calculated the change in the average number of medications and doses from admission to discharge . The number of medications in the intervention group decreased by 0.92 per patient , and increased by 1.65 in the control group ( P < .001 ) . The mean number of doses per day in the intervention group decreased by 2.47 per patient and increased by 3.83 in the control group ( P < .001 ) . CONCLUSIONS This simple intervention had a significant impact on medication regimen complexity in this population . Apparently , physicians were able to address polypharmacy when the issue was brought to their attention CONTEXT Data on the range of prescription and over-the-counter drug use in the United States are not available . OBJECTIVE To provide recent population -based information on use of all medications , including prescription and over-the-counter drugs , vitamins and minerals , and herbal preparations/natural supplements in the United States . DESIGN , SETTING , AND PARTICIPANTS Ongoing telephone survey of a r and om sample of the noninstitutionalized US population in the 48 continental states and the District of Columbia ; data analyzed here were collected from February 1998 through December 1999 . MAIN OUTCOME MEASURE Use of medications , by type , during the preceding week , compared by demographic characteristics . RESULTS Among 2590 participants aged at least 18 years , 81 % used at least 1 medication in the preceding week ; 50 % took at least 1 prescription drug ; and 7 % took 5 or more . The highest overall prevalence of medication use was among women aged at least 65 years , of whom 12 % took at least 10 medications and 23 % took at least 5 prescription drugs . Herbals/supplements were taken by 14 % of the population . Among prescription drug users , 16 % also took an  herbal/supplement ;  the rate of concurrent use was highest for fluoxetine users , at 22 % . Reasons for drug use varied widely , with hypertension and headache mentioned most often ( 9 % for each ) . Vitamins/minerals were frequently used for nonspecific reasons such as " health " ( 35 % ) ; herbals/supplements were also most commonly used for " health " ( 16 % ) . CONCLUSIONS In any given week , most US adults take at least 1 medication , and many take multiple agents . The substantial overlap between use of prescription medications and herbals/supplements raises concern about unintended interactions . Documentation of usage patterns can provide a basis for improving the safety of medication use OBJECTIVE To examine the effects of medication review s by primary care physicians on prescriptions written for elderly members of a Medicare managed care organization who were at risk for polypharmacy . STUDY DESIGN Prospect i ve study with follow-up survey . PATIENTS AND METHODS We conducted a study in 1995 to demonstrate the prevalence of polypharmacy ( defined as receiving 5 or more prescription medications during the 3-month study period ) among elderly members of our managed care organization . Two years later , elderly members identified as being at risk for polypharmacy were sent a letter encouraging them to schedule a medication review with their primary care physician . Each primary care physician was provided with clinical practice guidelines on polypharmacy and patient-specific medication management reports . Patients and physicians were subsequently mailed a survey to assess the impact of the medication review program on prescribing practice s. RESULTS Of 37,372 elderly members screened , 5737 ( 15 % ) were at risk for polypharmacy . Of these , 2615 ( 46 % ) responded to the follow-up survey . Of the survey respondents , 1087 ( 42 % ) had gone to their primary care physician for a medication review . During the review , 96 % of patients discussed their prescription medications and 72 % discussed nonprescription medications they were taking . Twenty percent reported that their physician discontinued medications , 29 % reported that the physician changed the dose of a medication , and 17 % informed their physician about a new prescription or nonprescription medication they were taking . Of the 275 primary care physicians surveyed , 56 ( 20 % ) returned the question naire . Of these , 61 % reported that the medication review program was " very " or " somewhat useful . " Thirty-five percent reported discontinuing unnecessary medications , and 23 % reported decreasing the frequency of dosing . Overall , 45 % of physicians reported making at least one change in their prescribing to a member at risk for polypharmacy . CONCLUSIONS Our program promoting medication review s between primary care physicians and their elderly patients result ed in significant changes in prescribing by physicians . This type of program is likely to decrease the risk of polypharmacy among older members of a Medicare managed care organization Inappropriate medication prescribing is an important problem in the elderly , but is difficult to measure . As part of a r and omized controlled trial to evaluate the effectiveness of a pharmacist intervention among elderly veterans using many medications , we developed the Medication Appropriateness Index ( MAI ) , which uses implicit criteria to measure elements of appropriate prescribing . This paper describes the development and validation of a weighting scheme used to produce a single summated MAI score per medication . Using this weighting scheme , two clinical pharmacists rated 105 medications prescribed to 10 elderly veterans from a general medicine clinic . The summated score demonstrated acceptable reliability ( intraclass correlation co-efficient = 0.74 ) . In addition , the summated MAI adequately reflected the putative heterogeneity in prescribing appropriateness among 1644 medications prescribed to 208 elderly veterans in the same general medicine clinic . These data support the content validity of the summated MAI . The MAI appears to be a relatively reliable , valid measure of prescribing appropriateness and may be useful for research studies , quality improvement programs , and patient care Objective : To determine whether two different educational interventions would reduce polypharmacy in out patients receiving ten ( 10 ) or more active medications at the Denver Veterans Affairs Center . Design : 292 patients were r and omized into three ( 3 ) groups : Control ( n=88 ) ; simple notification of primary care provider ( n=102 ) ; intensive notification , provision of pharmacy profiles , compliance index , and chart review by senior clinician with recommendations ( n=104 ) . Setting : Veterans Affairs Medical Center affiliated with the University of Colorado Health Sciences Center . Patients / Participants : All patients receiving greater than ten ( 10 ) active medications who are followed by clinic staff at the Denver VAMC . The mean age was 62 years ( range 26–88 ) and 96 % were male . Interventions : The simple notification group received only a single letter recommending that the patient ’s number of medications be reduced . The intensive notification group received more sophisticated intervention with a chart review , two letters with calculation of patient compliance , and individualized suggestions for reduction in polypharmacy . The control group received no intervention . Measurements and main results : Control patients had significantly less reduction in polypharmacy then either the simple or intensive intervention groups at four months ( p=0.028 ) . There was no significant difference between the intervention groups ( p=0.189 ) . By six months the difference was no longer significant . Conclusions : A simple intervention can result in a significant reduction in the number of medications 
    Output:
    
A recent nested case-controlled study in a large multispecialty group revealed an association between number of medications , doses of medications , and adverse drug events .
Practice