Drugs and the elderly, Part 2: Strategies for improving prescribing in a managed care environment.
OBJECTIVE: In part 1 of "Drugs and the Elderly" (December 2000 issue), we reviewed and summarized the vast amount of clinical information on medication use in the elderly for healthcare providers and administrators within managed care. In part 2, we explore the literature on improving prescribing, focusing on those approaches most likely to be useful within a managed care environment. STUDY DESIGN: We reviewed the general literature on medication use in the elderly, focusing on problems and systems approaches to the improvement of medication use in managed care. We created a topic list of general interest to health professionals within managed care and fit the available information into those topics. Thus, the result is an authoritative review rather than a systematic literature review. PATIENTS AND METHODS: Nonquantitative evaluation of the medical literature. RESULTS: We identified several hundred articles describing issues related to medication use in the elderly but only a trivial number that in any way addressed the managed care community directly. There is very little literature on how managed care can best incorporate the lessons of geriatric pharmacology and pharmacy. CONCLUSIONS: There is a paucity of literature for the managed care community of health professionals regarding pharmacology, pharmacoepidemiology, drug utilization review, and other issues related to the use of medication in the elderly population.