Geriatric Utilization of Drugs on the BEERs List: Physician Prescribing and Implications for Pharmacist Provided Medication Therapy Management (MTM)

Objective: Drug prescribing patterns reveal that elderly patients were prescribed inappropriate medications at 8% of doctor visits. A panel of geriatric medicine and pharmacology experts published the BEERs list as guidance for medication dispensing for seniors. Of 677,580 patients receiving prescriptions through Medicare Part D, 31.9% received a potentially inappropriate medication. The objective of this study was to identify drugs most commonly prescribed to geriatric patients, to compare those drugs to the BEERs list and to provide adverse effects (AE) that could be minimized through MTM. Methodology: The list of 135 drugs utilized for comparison was derived from three sources (NewWest, Propublica, Aetna) and represents the most commonly dispensed and/or sold prescriptions for Medicare Part D (CMS 2013). This list was compared to BEERs list (2015). To identify MTM examples, a literature search using PubMed, Medline, CINAHL and Google Scholar was performed from 2010-2015. Key search terms were “seniors”, “geriatrics”, “medication therapy management” and “adverse effects.” Articles were excluded if they were not in English or lack detailed adverse effects. Results: Upon comparison, 15 of the 135 drugs were listed on the BEERs list and deemed inappropriately prescribed. Specifically, antipsychotics with AE of orthostatic hypotension, bradycardia, increased fall risk and high abuse potential should be avoided. Commonly prescribed, antipsychotic, quetiapine has a black box warning of increased mortality in elderly patients with dementia-related psychosis. The most frequently prescribed inappropriate drugs were antihypertensive valsartan, proton pump inhibitor omeprazole, and antipsychotics quetiapine and olanzapine. The majority of the 11 MTM articles retrieved were observational studies. Common AE were sedation, tardive dyskinesia, anticholinergic effects and prolonged hypoglycemia. Conclusion: The BEERs list was developed as a safeguard against inappropriate care for the elderly. A 2010 study examined pharmacist provided MTM and found that drug problems were identified for over 85% of the geriatric population, improved health outcomes for over 50% and reduced cost overall. Future research should focus on examining the MTM impact on AE reduction and the economic impact of inappropriate prescribing.