This experimental study will test the feasibility and effectiveness of a screening instrument in a primary care setting in identifying older individuals at high risk for drug side effects. The objective is to sensitize clinicians to this possibility thus increasing communication with patients around drugs and increasing more aggressive detection and management. This study grows out of an earlier work which established significant unperceived, highly probable drug side effects in an older population. The study will be carried out in two neighborhood health centers with similar populations and staff. One Center will have the results of a screening instrument establishing symptoms and current drug regimens fed back to clinicians and the other centers will serve as the control site with no feedback taking place. Approximately 1,100 patients will be enrolled and information gathered on patients and clinicians in both settings. The immediate or short term effect of the experiment will be measured through comparing the experimental with the control group on communication around drugs, detection of possible side effects and increased management of confirmed side effects. The long-term effects will be measured by changes in functional decrements associated with side effects and by ongoing changes in clinician attitudes and behaviors toward management of drug regimens. The study hypothesizes that the experimental group will show greater communication between clinicians and patients, more detection of side effects and more management of such effects. Also, the clinicians in the experimental group will report continuing greater communication, detection and management at follow-up interviews. For patients, long term effects are hypothesized as less decrement in functioning for the experimental group. If these hypotheses are upheld the experimental intervention has potential as a simple strategy in primary care settings aimed at reducing drug side effects and their impact on patients. The prevalence of chronic disease in older populations who are living longer and the growing array of drugs for their treatment make it crucial that methods be developed to increase optimum management of drug regimens.
