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Implementation of clinical medication review in a geriatric ward to reduce potentially inappropriate prescriptions among older adults

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Abstract

Purpose

The impact of several pharmaceutical interventions to reduce the use of potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) has been recently studied. We aimed to determine whether clinical medication review (CMR) (i.e. a systematic and patient-centred clinical assessment of all medicines currently taken by a patient) performed by a geriatrician and a pharmacist added to standard pharmaceutical care (SPC) (i.e. medication reconciliation and regular prescription review by the pharmacist) resulted in more appropriate prescribing compared to SPC among older inpatients.

Methods

A retrospective observational single-centre study was conducted in a French geriatric ward. Six criteria for appropriate prescribing were chosen: the number of PIMs and POMs as defined by the STOPP/STARTv2 list, the total number of drugs prescribed, the number of administrations per day and the number of psychotropic and anticholinergic drugs. These criteria were compared between CMR and SPC group using linear and logistic regression models weighted on propensity scores.

Results

There were 137 patients included, 66 in the CMR group and 71 in the SPC group. The mean age was 87 years, the sex ratio was 0.65, the mean number of drugs prescribed was 9, the mean MMSE was 21 and at admission 242 POMs, and 363 PIMs were prescribed. Clinical medication review did not reduce the number of PIMs at discharge compared to SPC (beta = − 0.13 [− 0.84; 0.57], p = 0.71) nor did it reduce the number of drugs prescribed (p = 0.10), the number of psychotropic drugs (p = 0.17) or the anticholinergic load (p = 0.87). Clinical medication review resulted in more POMs being prescribed than in standard pharmaceutical care (beta = − 0.39 [− 0.72; − 0.06], p = 0.02). Cardiology POMs were more implemented in the medication review group (p = 0.03).

Conclusion

Clinical medication review did not reduce the number of PIMs but helped clinicians introduce underused drugs, especially cardiovascular drugs, which are known to be associated with morbidity and mortality risk reduction.

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Acknowledgements

The authors would like to thank Romain Leguillon for his kind support

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Authors and Affiliations

  1. Department of Geriatrics, University Hospital of Caen Normandie, Caen, France

    Alexandre Meurant, Pascale Lescure, Claire Lafont, Wilhelm Pommier, Claire Delmas, Pablo Descatoire & Cédric Villain

  2. Department of Pharmacy, University Hospital of Caen Normandie, Caen, France

    Alexandre Meurant, Marie Baudon & Alexandra Muzard

  3. Normandie University, Unicaen, INSERM U1075, COMETE, Caen, France

    Pablo Descatoire & Cédric Villain

  4. Department of Pharmacy, Vire Hospital, Vire, France

    Jean-Pierre Jourdan

  5. Normandie University, UNICAEN, CERMN (Centre d’Etudes et de Recherche sur le Médicament de Normandie), F-14032, Caen, France

    Jean-Pierre Jourdan

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  1. Alexandre Meurant
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Contributions

Alexandre Meurant, Cédric Villain and Jean-Pierre Jourdan wrote the main manuscript. All authors reviewed the manuscript and contributed to implementing clinical medical reviews in the acute geriatric ward.

Corresponding author

Correspondence to Alexandre Meurant.

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The local research ethics committee approved this study.

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Due to the retrospective design of this study, consent was not necessary to include patients, in accordance with the current Jardé’s Law.

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The authors declare no competing interests.

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Meurant, A., Lescure, P., Lafont, C. et al. Implementation of clinical medication review in a geriatric ward to reduce potentially inappropriate prescriptions among older adults. Eur J Clin Pharmacol 79, 1391–1400 (2023). https://doi.org/10.1007/s00228-023-03551-y

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