Specialist teleconsultation and changes in potentially inappropriate medication regimens among older adults in primary care: The AMELIORATION retrospective cohort study
Tarso Augusto Duenhas Accorsi, Juan Manuel São Bento Batista, Carlos Francisco da Silva, Flavia Oliveira Rodrigues, Anderson Aires Eduardo, Flavio Tocci Moreira, Karen Francine Köhler, Carlos Henrique Sartorato PedrottiBackground
Potentially inappropriate medication (PIM) prescribing in older adults contributes to adverse drug events and healthcare utilization. Synchronous specialist teleconsultation may expand access to medication review, but its association with prescribing appropriateness across multiple specialties remains uncertain.
Objectives
To assess changes in documented and specialist-recommended PIM regimens immediately following specialist teleconsultation.
Design
Retrospective, paired pre-post observational cohort study.
Methods
We analyzed 14,995 completed teleconsultation encounters involving 13,580 unique adults aged 60 years or older in the Brazilian TeleAMES program from March 2020 through February 2025. Each encounter contributed a medication regimen documented by the primary care clinician before consultation and a regimen recommended by the specialist after consultation. PIMs were classified according to the 2023 American Geriatrics Society (AGS) Beers Criteria. The primary outcome was the encounter-level proportion with at least one PIM. Paired binary comparisons and generalized estimating equation (GEE) models with patient-level clustering were used. Regression models included time (before versus after) as the sole predictor and were not adjusted for baseline covariates.
Results
The proportion of encounters with at least one PIM decreased from 32.7% to 29.6%, an absolute reduction of 3.1 percentage points and a relative reduction of 9.5% (p = 0.03). The mean PIM count also decreased (incidence rate ratio [IRR], 0.971; 95% confidence interval [CI], 0.952-0.991; p = 0.004). Count rates declined for drug-disease contraindications (IRR, 0.631; 95% CI, 0.601-0.663; p < 0.001), high-risk drug-drug interactions (IRR, 0.766; 95% CI, 0.672-0.873; p < 0.001), and medications requiring renal dose adjustment (IRR, 0.929; 95% CI, 0.901-0.958; p < 0.001). The largest specialty-specific absolute reductions were observed in Cardiology (34.2% to 21.4%) and Endocrinology (38.1% to 22.3%).
Conclusion
Immediately after specialist teleconsultation, specialist-recommended regimens contained fewer PIMs, particularly within high-risk prescribing domains. Because post-consultation lists represented recommendations rather than confirmed dispensing, implementation, or medication use, and because no concurrent control group was available, these findings indicate an association with documented prescribing changes rather than a causal reduction in medication exposure.