Collaborative intervention between pharmacists and physicians on elderly patients: a randomized controlled trial

Abstract

BackgroundThe elderly population is the largest consumer of medications as this age group is at high risk for developing chronic diseases. However, medication use among elderly people is complicated by an increased risk of drug-related problems. Therefore, the present study was conducted to investigate the effects of collaborative interventions between pharmacists and physicians on health-related outcomes of elderly patients.Patients and methodsThis was a randomized controlled trial (RCT) conducted on elderly outpatients who sought treatment in the Medical Outpatient Department of a public tertiary hospital in Malaysia and who were taking at least five medications. The participants were randomly allocated to the intervention and control groups. The intervention group received pharmaceutical care from a pharmacist in collaboration with physicians and was followed-up for 6 months, while the control group received usual care in the outpatient pharmacy.ResultsA total of 73 participants in the intervention group and 79 participants in the control group completed the study. Participants in the intervention group had significantly better medication adherence (median =7.0 vs 5.0, U=1224.5, p<0.001, r=0.503) and better Medication Appropriateness Index (MAI) score (median =8.0 vs 20.0, U=749.5, p<0.001, r=0.639).ConclusionCollaborative interventions between pharmacists and physicians improved medication adherence and MAI scores of the elderly patients. Therefore, such services should be implemented in all hospitals, especially in countries where pharmacists are still not playing a substantial role in patient care.Trial registrationNMRR-12-958-13020.

Prevalence of Drug-Related Problems and Complementary and Alternative Medicine Use in Malaysia: A Systematic Review and Meta-Analysis of 37,249 Older Adults

“…The 27 studies included in the systematic review represented a pool of 37,249 patients, 29,342 of whom were further included in the meta-analysis. Fourteen studies were conducted in the Central region of Malaysia [6,13,[16][17][18][19][20][21][22][23][24][25][26][27], three in the Northern [14,28,29] and Eastern Regions each [11,30,31], and one in Borneo [15]. Three of them were nationwide studies [32][33][34], while the remaining three studies did not specify the participants' regions [35][36][37].…”

“…The prevalence of polypharmacy reported in Malaysia widely varied from 45.9% to 80.6% [11][12][13], while almost one-third of the elderly in the country are using PIMs [13,14]. Nonadherence to treatment was also reported in more than half of Malaysian elderly [15]. Nearly 60% of the elderly also regularly consume supplements [13], while approximately one-fifth of them use CAM [16].…”

Perspectives of primary care physicians and pharmacists on interprofessional collaboration in Kuwait: A quantitative study

“…Several studies have demonstrated the benefit of a pharmacist/physician collaborative practice model in improving the management of chronic diseases such as hypertension, dyslipidemia, arrhythmias, heart failure, diabetes, asthma, osteoporosis, and psychiatric disorders. The benefits of collaboration include increased medication appropriateness, decreased occurrence of medication-related problems, medication errors and adverse drug reactions, increased communication with patients, improved patients' medication knowledge and adherence, decreased morbidity and mortality, improved patient health outcomes, reduced physician workload, and decreased healthcare costs [11][12][13][14][15][16][17][18][19]. As a result of this mounting evidence, there is a growing call for increased pharmacist-physician collaboration [20].…”

<p>Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study</p>

“…1 With aging, the prevalence of diseases and geriatric syndromes increases; as a consequence, the elderly population is more frequently exposed to complex medication regimens and increased drug use. [2][3][4][5] Polypharmacy increases the risk of drug-related problems (DRPs), potentially inappropriate use of medications (PIMs), and hospitalizations, all of which are common among elderly people. 2,3,6,7 A DRP is defined as "an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes".…”

“…9,10 Several studies have found that pharmacists provide added value in resolving and preventing DRPs in settings such as outpatient clinics, acute care in inpatients, nursing homes, and palliative care. 5,[11][12][13][14][15][16][17][18] Studies from inpatient settings have also shown that including a pharmacist as a member of the interdisciplinary health care team may improve outcomes and decrease drug-related readmissions and mortality in geriatric patients. 2,17,[19][20][21] As team members, pharmacists offer an additional perspective in the application of medication reviews, resulting in an increase in detection of DRPs and a reduction of polypharmacy in elderly inpatients.…”