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Abstract

Background: The purpose of this project was to conduct pharmacotherapeutic management of patients in the outpatient setting in a standardized manner. A CMR program was implemented at select ambulatory care sites within our healthcare system. This review identified and addressed medication-related concerns in order to optimize disease state management and attain positive patient outcomes. Methods: This prospective review included patients 80 years or older with polypharmacy concerns, categorized as having greater than 10 medications. Evaluation assessed for therapeutic duplications, potential interactions, side effects, inappropriate medications in the elderly, pharmacoeconomic issues and adherence concerns. All data was collected through the outpatient electronic health record. The primary outcome was the number and type of interventions identified through CMR. Secondary outcomes included percent of recommendations accepted, reasons for rejection, types of recommendations, and disease states intervened on. Results: Out of a total of 222 patients, 52 patients did not require any interventions and 250 recommendations were made to the providers on the 170 remaining patients. Currently 82% of recommendations were accepted by providers, with 17% still pending provider acknowledgement, and 1% being rejected. A large majority, 141 recommendations, were made in regards to high risk medications. Conclusion: CMR was shown to be highly effective in identifying appropriate medication interventions in order to optimize patient care. This study provided the framework to move pharmacists into other outpatient sites in the healthcare setting to assist in targeting inappropriate prescribing in the elderly.