Drug related problems identified by pharmacist in geriatric inpatients in university teaching hospital

Abstract

Background The elderly population is often exposed to complex medication regimens. Increased drug use is one of the main reasons for drug-related problems (DRPs). Aim The primary objective of this study was to define and classify DRPs in patients admitted at the Clinical Department of Geriatrics, Zvezdara University Medical Center, Belgrade, Serbia. Method Patient demographics, medications, and medical history were evaluated by the pharmacist during a weekly 3-hour visit for a period of 5 months. The DRPs were identified via V9.0 PCNE classification. Lexicomp® was used to assess the drug–drug interactions. Results A total of 100 geriatric patients were included in the study (mean age 79.7 ± 7.88 years; median [IQR] of prescribed drugs 8, 5 [6–10]). Total 236 potential DRP were identified and at least one potential DRP was seen in 85% of the patients. The most common underlying DRP concerned incorrect dose (36%), inappropriate drug combination (17.8%), untreated indication (17.4%) and drugs without indication (16.5%). There were significant correlations (p ≤ 0.05) between DRPs and number of comorbidities (r = 0.33) and number of drugs used (r = 0.6). Patients with atrial fibrillation, cardiomyopathy, diabetes mellitus and chronic renal failure had significantly more DRPs in comparison to the patients without these co-morbidities. Conclusion Pharmacist was able to detect a high number of DRPs in older patients. The role of the clinical pharmacist might be to improve treatement safety, to adjust the dosage, to detect the over- and underuse of drugs, since these were the most encountered causes of DRPs.