Effect of a Pharmacist-Driven Medication Management Intervention Among Older Adults in an Inpatient Setting

  • Sara AlosaimyEmail author
  • Alka Vaidya
  • Kevin Day
  • Gretchen Stern
Original Research Article



Older adults have a seven times greater risk than younger adults of being hospitalized due to an adverse drug event.


The objective of this study was to compare the number of potentially inappropriate medications (PIMs) on admission to the number of PIMs on discharge following pharmacist intervention.

Patients and Methods

This was a prospective, single-center pilot study performed at a tertiary medical center. Eighty-two adults aged 65 years or older on five or more medications who were admitted to the general medicine floor between December 2016 and May 2017 were included in the analysis. Pharmacists completed a review of prior admission medications and identified PIMs. Recommendations for PIMs were communicated to the medical team and documented in the patient’s electronic medical record. PIMs were measured by the use of validated screening tools and an assessment of patient-specific parameters.


Fifty-two percent of our patients were taking at least one PIM. The average number of PIMs on admission was found to be 0.84 ± 1.12. Pharmacist intervention resulted in a statistically significant reduction to an average of 0.56 ± 0.91 PIMs (P < 0.01). The mean time to complete the medication therapy management (MTM) process was 49.39 ± 16.2 min per patient.


While pharmacist-driven MTM significantly reduced PIMs in our study, the implementation of this model in the inpatient setting faces several challenges.



The authors of this study would like to thank Kaitlin Crowley and Kevin Charles McLaughlin for their contribution to the medication therapy management process.

Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this study.

Conflict of interest

Sara Alosaimy, Gretchen Stern, Alka Vaidya, and Kevin Day declare that they have no conflict of interest with the content of the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pharmacy ServicesBrigham and Women’s HospitalBostonUSA

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