Improvement on prescribing appropriateness after implementing an interdisciplinary pharmacotherapy quality programme in a long-term care hospital

Abstract

ObjectivesTo determine the prevalence of inappropriate prescribing in elderly patients with polypharmacy admitted to a long-term care hospital (LTCH) and to evaluate the impact of an interdisciplinary pharmacotherapy quality programme on improvement of prescribing appropriateness.MethodsAn interventional, longitudinal, prospective study was conducted in a Spanish LTCH (October 2013 to July 2014) including 162 elderly (≥70 years) patients with polypharmacy (≥5 medications). Pharmacists conducted the pharmacotherapy follow-up of patients with medication reconciliation, pharmacotherapeutic optimisation and educational interviews from admission to discharge. Reconciliation errors, potentially inappropriate medications (PIMs), potentially prescribing omissions (PPOs) and significant drug interactions rates were calculated. The impact of the programme was evaluated considering the difference between the inappropriateness score per patient (total number of reconciliation errors, PIMs, PPOs and significant drug interactions) before and after implementing pharmacotherapy recommendations.ResultsAt admission, 163 reconciliation errors (median(range), 1(1-6)) in 92 (56.8%) patients (65.6% drug omissions), 335 PIMs (2(1-6)) in 147 (90.7%) patients (39.3% use ≥2 anticholinergic drugs), 43 PPOs (1(1-3)) in 32 (19.8%) patients (48.5% statin omission) and 594 significant drug interactions (4(1-19)) in 130 (80.2%) patients were detected. After implementing pharmacotherapy recommendations, statistically significant reductions in admission reconciliation errors (8.3% to 0.1%), PIMs (17.0% to 12.2%), PPOs (2.2% to 0.7%) and significant drug interactions (30.2% to 26.8%) rates were found. The programme achieved a 31% improvement in prescribing appropriateness, with a statistically significant reduction in the inappropriateness score (6(IQR:4–9) to 4(IQR:2–7)).ConclusionReconciliation errors, PIMs and drug interactions are highly prevalent in elderly patients with polypharmacy admitted to an LTCH. This interdisciplinary pharmacotherapy quality programme seems to be a useful approach in the improvement of prescribing appropriateness in a high-risk older population.

Community‐based pharmacists' role in deprescribing: A systematic review

“…The use of tools proved to be valuable in a long-term care hospital resulting in a 31% improvement in prescribing appropriateness and led to deprescribing. 42 Although the study was conducted in a different care setting, it is reasonable to expect positive results to be translated amongst patients residing in community healthcare. Available tools and aids warrant a critical approach when applying to different settings and patients and should not replace a personalised approach to every deprescribing case.…”

“…Most tools were developed for elderly patients with polypharmacy and polymorbidity and for inpatient settings. The use of tools proved to be valuable in a long‐term care hospital resulting in a 31% improvement in prescribing appropriateness and led to deprescribing 42 . Although the study was conducted in a different care setting, it is reasonable to expect positive results to be translated amongst patients residing in community healthcare.…”

Integrating the clinical pharmacist into the emergency department interdisciplinary team: a study protocol for a multicentre trial applying a non-randomised stepped-wedge study design

“…This is traditionally done by medication history taking, medication reconciliation (MedRec), medication review (MedRev) and medication counselling, but requires working directly with patients, physicians and other healthcare professionals and includes communication to ensure that medications are correctly used. [1][2][3][4][5][6] The employment of clinical pharmacists in hospitals has shown improvement in many aspects of medicines safety, for example, prescribing appropriateness with reduction of potentially inappropriate medications from 17.0% to 12.2%, reduction of potentially prescribing omissions from 2.2% to 0.7% 7 and increased appropriate use of antimicrobials with almost 80% acceptance rate of pharmacist recommendations. 8 Seven of twelve trials in a review by Kaboli et al reported on reduction of DRPs and medication errors.…”

The effects of a pharmacist-led medication review in a nursing home

“…Pharmacist participation has been shown to improve the quality of medication reconciliation in a number of studies [10,16–21] . Pharmacists can identify more nonprescription and herbal medications than physicians or nurses using the medication reconciliation approach when patients are admitted to hospital [16] .…”

“…Most studies on medication reconciliation by pharmacists were shown to be effective or beneficial. However, the overall results of medication reviews or medication reconciliation remain controversial due to different study designs, research settings, consensus of the pharmaceutical intervention, institutional settings, and the ages of the studied populations [10,18–21] . The majority of such studies are undertaken in a hospital setting.…”