Clinical Pharmacist Intervention Reduces Potentially Inappropriate Prescriptions in a Geriatric Perioperative Care Unit Dedicated to Hip Fracture

Abstract

<b><i>Introduction:</i></b> Clinical pharmacist (CP) intervention improves drug prescription by identifying potentially inappropriate prescriptions (PIPs). Geriatric perioperative care units (UPOGs) provide enhanced care for patients with hip fracture, including drug prescription. However, it is not known whether adding a CP intervention in a UPOG decreases the number of PIPs. This study aimed to evaluate the effect of a CP intervention, combining an implicit and an explicit method, on the number of PIPs in a UPOG. <b><i>Methods:</i></b> This single centre before-after-control-impact study recruited patients aged over 75 years admitted to a UPOG for a hip fracture. The “control group” (“before period”) received usual care including two medication reconciliations, one at admission and one at discharge. The “intervention group” (“after period”) received usual care and a CP intervention including two medication reconciliations, a medication review with two tools, STOPP/START and Medication Appropriateness Index, and a meeting between a CP and geriatricians. PIPs were assessed in both groups by STOPP/START and Medication Appropriateness Index and compared from hospital admission to discharge. <b><i>Results:</i></b> A total of 209 patients were included, 150 in the control group and 59 in the intervention group (mean age: 87.2 ± 5.9 years). The number of PIPs decreased in both groups from hospital admission to discharge (<i>p</i> < 0.001). The number of PIPs, potentially inappropriate medications, and potential prescribing omissions decreased more in the intervention group than in the control group (adjusted intervention effect: −2.46 (95% CI: −2.63; −2.24); −1.13 (95% CI: −1.27; −0.98); and −1.35 (95% CI: −1.52; −1.18), respectively, <i>p</i> < 0.001 for all). <b><i>Discussion/Conclusion:</i></b> A CP intervention with an explicit and implicit method improved prescriptions in a UPOG. Further randomized studies are necessary to evaluate the effect of a CP intervention on adverse drug events, health costs, and mortality.

Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial

“…Previous studies have described prevalent use of PIMs in hip fracture patients, such as falls-risk increasing drugs [ 23 , 64 ]. Our results are comparable to previously described clinical pharmacist initiatives, which have reduced PIMs in older inpatients [ 65 ], outpatient clinics [ 66 ], and hip fracture patients [ 35 ]. Through less PIMs and a higher proportion receiving osteoporosis therapy, the intervention patients may have experienced fewer fractures and a lower mortality if observed for a longer period than in this study, e.g.…”

“…Previous studies have included clinical pharmacists in discharge management and care transitions, which resulted in optimised medication information and reduced discrepancies [11,[29][30][31][32]. Through the medication reviews, clinical pharmacists have contributed to optimised pharmacotherapy by reducing the number of PIMs, suggested to start recommended therapies, and increasing medication appropriateness [33][34][35]. Furthermore, clinical pharmacist interventions have also shown to reduce readmissions and mortality [36,37].…”

Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study

“…Remarkably, previous reports have shown that including pharmacists in multidisciplinary geriatric teams provides more benefits than isolated pharmacists’ interventions [ 20 ]. Moreover, a recent report has demonstrated that the intervention of a clinical pharmacist can improve medical prescriptions by diminishing the total PIDP incidence in a cohort of older patients admitted for acute hip fracture [ 36 ]. In a small intervention cohort of 59 patients, Leguillon et al obtained a reduction around 65% of total PIDP between admission and discharge.…”

“…In a small intervention cohort of 59 patients, Leguillon et al obtained a reduction around 65% of total PIDP between admission and discharge. This effect clearly improves the comparison of the control group that, without the involvement of a clinical pharmacist, achieves a very slight prescription adequacy in terms of PIDP incidence [ 36 ].…”

Best Possible Medication History Collection by Clinical Pharmacist in a Preoperative Setting: An Observational Prospective Study

“…These studies highlight the positive impact of clinical pharmacists in mitigating medication omissions, addressing incompleteness in treatment plans and reducing the risk of adverse events associated with patient therapy. Incorporating clinical pharmacists into surgical teams can lead to improved medication management and enhanced patient safety during the perioperative period [3,[6][7][8]. A 2.7-fold increase in the risk of experiencing postoperative complications has been revealed in surgical patients treated with preadmission medications compared to those not taking preadmission medications [9].…”