Efficacy of a Pharmacist Team Clinical Medication Review in Older Adults: A Prospective and Retrospective Observational Study

Abstract

Polypharmacy in older adults causes problems such as increased adverse drug reactions, overdose or duplication, and poor medication adherence. We have established a "medication review team" organized by pharmacists. This prospective and retrospective observational study evaluated the effectiveness of the pharmacist-led team-based approach for reducing polypharmacy as compared to the individual pharmacist approach. Data on the individual pharmacist approach were collected retrospectively, but prospectively for the pharmacist-led team approach. The study included patients who were admitted to the nephrology, orthopedic surgery, and psychiatry wards. Characteristics for patient included in each study group were adjusted using the propensity score method. The pharmacist-led team approach had a significantly higher medication change rate compared to that of the individual pharmacist approach (odds ratio (OR), 2.28; 95% confidence interval (CI), 1.21 to 4.46; p 0.009). The rate of patients with two or more medication discontinuations and the rate of patients with intervention by young clinical pharmacist were also significantly higher in the pharmacist-led team approach (OR, 2.19; 95% CI, 1.06 to 4.74; p 0.03 and OR, 5.67; 95% CI, 1.22 to 53.15; p 0.02, respectively). The rate of patients with discontinuation of potentially inappropriate medications was not significantly different between the two groups (OR, 2.07; 95% CI, 0.86 to 5.33; p 0.11). Our results suggest that it is possible to improve the quality of medication review by conducting team conferences even with only pharmacists.

Anorexia Assessed by Simplified Nutritional Appetite Questionnaire and Association with Medication in Older Patients Undergoing Hemodialysis

“…37) Identifying unnecessary medications would also result in a reduction in medical expenditure. 10,38) This study had several limitations. First, causal relationships could not be clarified because this was a cross-sectional study.…”

Deprescribing psychotropic drugs in a geriatric psychiatry outpatient clinic

“…These results are consistent with previous studies that have demonstrated the importance of a pharmacist-led medication review in a multidisciplinary team. [27][28][29] In a Slovenian study involving psychogeriatric outpatients, pharmacists proposed 374 psychopharmacotherapy interventions (61.5% drug discontinuations, 28.6% drug initiations, and 10.9% dose adjustments) and the physicians accepted 45.2% of them. The interventions reduced the total number of medications per patient, PIMs, potential drug-drug interactions, and resulted in greater adherence to treatment guidelines.…”

Prevalence and influence factor of drug-related problems in inpatients with kidney disease: A prospective single central study

“…Renal disease is frequently accompanied by hypertension and diabetes mellitus, among other chronic conditions; therefore, the patient's conditions are more complicated, requiring the use of multiple medications and increasing the risk of drug interactions. The dose of medicine should be adjusted according to the patient's renal function and administered with great care [1]. The increase in the quantity and diversity of medications consumed by patients not only decreases compliance but also elevates the prevalence of drug-related problems (DRPs).…”