The Impact of a Structured Pharmacist Intervention on the Appropriateness of Prescribing in Older Hospitalized Patients
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Throughout the literature, drug-related problems (DRPs), such as medication reconciliation issues and potentially inappropriate prescribing, have been reported to be associated with adverse outcomes in older individuals. Both structured pharmacist review of medication (SPRM) interventions and computerized decision support systems (CDSSs) have been shown to reduce DRPs.
The objectives of this study were to (i) evaluate the impact of a specially developed SPRM/CDSS intervention on the appropriateness of prescribing in older Irish hospital inpatients, and (ii) examine the acceptance rates of these recommendations.
We prospectively reviewed 361 patients, aged ≥65 years who were admitted to an Irish university teaching hospital over a 12-month period. At the point of admission, the patients received a SPRM/CDSS intervention, which screened for DRPs. Any DRPs that were identified were then communicated in writing to the attending medical team. The patient’s medical records were reviewed again at 7–10 days, or at the point of discharge (whichever came first).
Of the 361 patients reviewed, 181 (50.1 %) were female; the median age was 77 years [interquartile range (IQR) 71–83 years). A total of 3,163 (median 9, IQR 6–12) and 4,192 (median 12, IQR 8–15) medications were prescribed at admission and discharge, respectively. The SPRM generated 1,000 recommendations in 296 patients. Of the 1,000 recommendations, 548 (54.8 %) were implemented by the medical teams accordingly. The SPRM/CDSS intervention resulted in an improvement in the appropriateness of prescribing as defined by the medication appropriateness index (MAI), with a statistically significant difference in the median summated MAI at admission (15, IQR: 7–21) and follow-up (12, IQR: 6–18); p < 0.001. However, the SPRM did not result in an improvement in appropriateness of underprescribing as defined by a modified set assessment of care of vulnerable elders (ACOVE) criteria.
This study indicated that DRPs are prevalent in older Irish hospitalized inpatients and that a specially developed SPRM intervention supported by a CDSS can improve both the appropriateness and accuracy of medication regimens of older hospitalized inpatients.
KeywordsPharmaceutical Care Medication Reconciliation Potentially Inappropriate Prescribe Computerize Decision Support System Research Pharmacist
This study was funded by the Health Research Board (HRB) of Ireland. The authors of this study have no conflict of interest to declare. The authors thank the staff of the university teaching hospital in which this study was undertaken for their cooperation during the study period.
- 1.Central Statistic Office. Population and Labour Force Projections 2016–2046. Dublin: Government of Ireland; 2013. p. 2013.Google Scholar
- 2.Richardson K, Moore P, Peklar J, Galvin R, Bennett K, Kenny RA. Polypharmacy in adults over 50 in Ireland: Opportunities for cost saving and improved healthcare. Dublin: Trinity College Dublin; 2012.Google Scholar
- 5.Quelennec B, Beretz L, Paya D, et al. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013.Google Scholar
- 14.Resar R, Midelfort L. Medication reconciliation review. Boston: Institute for Healthcare Improvement; 2004.Google Scholar
- 15.World Health Organisation (WHO). Assuring Medication Accuracy at Transitions in Care. Geneva: World Health Organisation (WHO), 2007.Google Scholar
- 19.Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003 Dec 8–22;163(22):2716–24.Google Scholar
- 21.Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Deutsches Arzteblatt Int. 2010;107(31–32):543–51.Google Scholar
- 25.Campbell F, Karnon J, Czoski-Murray C, Jones R. A systematic review of the effectiveness and costeffectiveness of interventions aimed at preventing medication error (medicines reconciliation) at hospital admission. Shellfield: The University of Sheffield, School of Health and Related Research (ScHARR); 2007.Google Scholar
- 29.Martin J. British National Formulary. London; 2011.Google Scholar
- 35.Tamblyn R, Huang A, Perreault R, et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ Canadian Med Assoc J J l’Assoc Med Canadienne. 2003;169(6):549–56.Google Scholar