Several randomized trials have tried to reduce excessive medications and inappropriate drugs use with different techniques in the elderly. Information with feedback to primary care physicians seems to be effective «Kroenke K, Pinholt EM. Reducing polypharmacy in the elderly. A controlled trial of physician feedback. J Am Geriatr Soc 1990 Jan;38(1):31-6. »1 «Meyer TJ, Van Kooten D, Marsh S, Prochazka AV. Reduction of polypharmacy by feedback to clinicians. J Gen Intern Med 1991 Mar-Apr;6(2):133-6. »2 «Lipton HL, Bero LA, Bird JA, McPhee SJ. The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing. A randomized controlled trial. Med Care 1992 Jul;30(7):646-58. »3 «Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR. A randomized, controlled trial of a clinical pharmacist intervention to improve inap»4 «Smith DH, Christensen DB, Stergachis A, Holmes G. A randomized controlled trial of a drug use review intervention for sedative hypnotic medications. Med Care 1998 Jul;36(7):1013-21. »5 «Fillit HM, Futterman R, Orland BI, Chim T, Susnow L, Picariello GP, Scheye EC, Spoeri RK, Roglieri JL, Warburton SW. Polypharmacy management in Medicare managed care: changes in prescribing by primary»6 «Soumerai SB, Avorn J. Predictors of physician prescribing change in an educational experiment to improve medication use. Med Care 1987 Mar;25(3):210-21. »7, especially with use of personal contact ("academic detailing") rather than just giving educational material «Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR. A randomized, controlled trial of a clinical pharmacist intervention to improve inap»4 «Smith DH, Christensen DB, Stergachis A, Holmes G. A randomized controlled trial of a drug use review intervention for sedative hypnotic medications. Med Care 1998 Jul;36(7):1013-21. »5 «Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing". N Engl J Med 1983 Jun 16;308(24):1457-63. »8 «Steele MA, Bess DT, Franse VL, Graber SE. Cost effectiveness of two interventions for reducing outpatient prescribing costs. DICP 1989 Jun;23(6):497-500. »9. However, few trials have followed-up the patients after the intervention is over, and it seems that the reduction of drugs is noteasy to sustain «Meyer TJ, Van Kooten D, Marsh S, Prochazka AV. Reduction of polypharmacy by feedback to clinicians. J Gen Intern Med 1991 Mar-Apr;6(2):133-6. »2 «Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR. A randomized, controlled trial of a clinical pharmacist intervention to improve inap»4 «»?. Nearly all trials have been explanatory in their nature thus excluding noncompliant patients before randomisation «Kroenke K, Pinholt EM. Reducing polypharmacy in the elderly. A controlled trial of physician feedback. J Am Geriatr Soc 1990 Jan;38(1):31-6. »1 «Lipton HL, Bero LA, Bird JA, McPhee SJ. The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing. A randomized controlled trial. Med Care 1992 Jul;30(7):646-58. »3 «Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR. A randomized, controlled trial of a clinical pharmacist intervention to improve inap»4 «Gilchrist WJ, Lee YC, Tam HC, Macdonald JB, Williams BO. Prospective study of drug reporting by general practitioners for an elderly population referred to a geriatric service. Br Med J (Clin Res Ed) »11. In addition, mere counting the prescribed medications may not be a reliable method to define the elderly person´s true use of medications «Pitkala KH, Strandberg TE, Tilvis RS. Is it possible to reduce polypharmacy in the elderly? A randomised, controlled trial. Drugs Aging 2001;18(2):143-9. »10.
Conclusion: It is not easy to reduce excessive drugs in real life. Some reductions may be archieved with tight control but after longer follow-up the number of drugs tend to return to its earlier level.
Comment: The quality of evidence is downgraded by indirectness (actual use of medication was not assessed, noncompliant patients were excluded) and study quality.