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The effect of an inpatient geriatric stewardship on drug-related problems reported by patients after discharge

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Abstract

Background Drug-related problems after discharge are common among older adults with polypharmacy. Medication review during hospitalization has been proposed as one solution. Inpatient medication review is often based on clinical records only. An obstacle is the lack of insight into the outpatient history. Therefore, a geriatric stewardship was designed and involved an inpatient medication review by a hospital pharmacist and geriatrician based on (I) clinical records to draft initial recommendations, (II) consultations with primary care providers (general practitioner and community pharmacist) to discuss the hospital-based recommendations, (III) patient interviews to assess their needs, and (IV) a multidisciplinary evaluation of all previous steps to draft final recommendations. Objective To assess the effect of the geriatric stewardship on drug-related problems reported by patients after discharge. Setting General teaching hospital. Methods An implementation study (pre–post design) was performed. Orthopaedic and surgical patients (≥ 65 years) with polypharmacy and a frailty risk factor were included. The pre-group received usual care, the post-group received the geriatric stewardship intervention. Two weeks post-discharge, patient-reported drug-related problems were assessed using a validated questionnaire. Drug-related problems were classified into drug-related complaints, practical problems, and questions about medication. Outcomes The outcomes were the number and type of drug-related problems per patient (primary) and the number of initial recommendations that were altered due to primary care provider and patient input (secondary). Results In total, 127 patients were analysed (usual care n = 74, intervention n = 53). Intervention patients reported fewer drug-related problems compared to usual care: 2.8 versus 3.3 per patient (Adjusted relative risk 0.83, 95% confidence interval 0.66–1.05). This difference resulted from a halving in drug-related complaints (p < 0.05), for example pain, drowsiness, nausea or constipation. Nearly 30% of the initial recommendations based on the clinical records were discarded or modified after primary care provider consultations and patient interviews. Conclusion The geriatric stewardship did not significantly reduce drug-related problems, but it significantly halved drug-related complaints. One-in-three initial recommendations were altered due to primary care provider and patient input. Inpatient medication reviews should not be based on clinical records only; they require transmural collaboration and patient participation to ensure continuity of patient care.

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Acknowledgements

We would like to acknowledge the patients involved in this study as well as the GPs and community pharmacists who participated. We also thank N. Khorsand, S.U. Kisoensingh, O.J. de Vries, T.H. Geersing, E.B. Uitvlugt, B. Nikolik, B.J.D. Gerritsen, M. Yilmaz, R. de Heij, and A.R.E. Wapstra for their assistance with the data collection, and W.H. Heideman and T. van der Ploeg for their help with the analysis.

Funding

No funding was received for performing this research.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, OLVG Hospital, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands

    Godelieve H. M. Ponjee, Marjo J. A. Janssen & Fatma Karapinar-Çarkit

  2. Department of Clinical Pharmacy, Amsterdam UMC-AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Godelieve H. M. Ponjee

  3. Section of Geriatric Medicine, Department of Internal Medicine, OLVG Hospital, Jan Tooropstraat 164, 1061AE, Amsterdam, The Netherlands

    Henk W. P. C. van de Meerendonk

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  1. Godelieve H. M. Ponjee
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Correspondence to Fatma Karapinar-Çarkit.

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Appendix 1: Questionnaire: structured telephone interview two weeks post-discharge

Appendix 1: Questionnaire: structured telephone interview two weeks post-discharge

A: Any symptoms

“I would like to discuss with you many common physical complaints. Not everyone suffers from these complaints, but it is possible. For each complaint I mention, can you indicate whether you are bothered by it?”

figure a

B: Practical problems

“Using medicines can sometimes cause practical problems. I will now mention a number of statements. For the statements, could you indicate whether you agree or disagree?”

figure b

C: Questions about medication

figure c

D: Satisfaction

figure d

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Ponjee, G.H.M., van de Meerendonk, H.W.P.C., Janssen, M.J.A. et al. The effect of an inpatient geriatric stewardship on drug-related problems reported by patients after discharge. Int J Clin Pharm 43, 191–202 (2021). https://doi.org/10.1007/s11096-020-01133-x

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