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International Journal of Clinical Pharmacy

, Volume 37, Issue 6, pp 1194–1205 | Cite as

Impact of an enhanced pharmacy discharge service on prescribing appropriateness criteria: a randomised controlled trial

  • Benjamin J. BasgerEmail author
  • Rebekah J. Moles
  • Timothy F. Chen
Research Article

Abstract

Background Older people are at increased risk of drug-related problems (DRPs) caused by inappropriate use or underuse of medications which may be increased during care transitions. Objective To examine the effects of applying a validated prescribing appropriateness criteria-set during medication review in a cohort of older (≥65 years) Australians at the time of discharge from hospital. Setting Private hospital and homes of older patients in Sydney, Australia. Methods Cognitively well English speaking patients aged 65 years or over taking five or more medications were recruited. A prescribing appropriateness criteria-set and SF-36 health-related quality of life health (HRQoL) survey were applied to all patients at discharge. Patients were then randomly assigned to receive either usual care (control, n = 91) or discharge medication counselling and a medication review by a clinical pharmacist (intervention, n = 92). Medication review recommendations were sent to the general practitioners of intervention group patients. All patients were followed up at 3 months post discharge, where the prescribing appropriateness criteria-set was reapplied and HRQoL survey repeated. Main outcome measures change in the number of prescribing appropriateness criteria met; change in HRQoL; number and causes of DRPS identified by medication review; intervention patient medication recommendation implementation rates. Results There was no significant difference in the number of criteria applicable and met in intervention patients, compared to control patients, between follow-up and discharge (0.09 ≤ p ≤ 0.97). While the difference between groups was positive at follow-up for SF-36 scores, the only domain that reached statistical significance was that for vitality (p = 0.04). Eighty-eight intervention patient medication reviews identified 750 causes of DRPs (8.5 ± 2.7 per patient). No causes of DRPs were identified in four patients. Of these causes, 76.4 % (573/750) were identified by application of the prescribing appropriateness criteria-set. GPs implemented a relatively low number (42.4 %, 318/750) of recommendations. Conclusion Application of a prescribing appropriateness criteria-set during medication review in intervention patients did not increase the number of criteria met, nor result in a significant improvement in HRQoL. Higher recommendation implementation rates may require additional facilitators, including a higher quality of collaboration.

Keywords

Australia DRPs Drug-related problems Inappropriate prescribing Overprescribing Prescribing appropriateness criteria Private hospital Underprescribing 

Notes

Acknowledgments

We acknowledge the support and assistance of the Medical Board of Wolper Jewish Hospital, Woollahra, Sydney, its nursing staff, rehabilitation specialists, resident medical officers and its former Chief Executive Officer, Mr Harry Aizenberg.

Funding

None.

Conflicts of interest

The authors declare no conflict of interest.

Supplementary material

11096_2015_186_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 kb)

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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Benjamin J. Basger
    • 1
    Email author
  • Rebekah J. Moles
    • 1
  • Timothy F. Chen
    • 1
  1. 1.Faculty of PharmacyThe University of SydneySydney, CamperdownAustralia

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