Pharmacist’s Comprehensive Geriatric Assessment: Introduction and Evaluation at Elderly Patient Admission

Abstract

BackgroundThe role of the clinical pharmacist within the healthcare system remains unclear.ObjectiveOur objective was to describe a pharmacist’s comprehensive geriatric assessment (pCGA) at admission of elderly patients and to assess its relevance in terms of medication compliance and pharmacist interventions (PIs).MethodsWe conducted a prospective interventional study over 29 months in a 34-bed medical/rehabilitation geriatric ward in a French geriatric hospital. At admission, patients received pharmaceutical care through a consistent three-step process: (1) pharmacists met with the patient to undertake cognitive screening and assess their medication adherence (using the Girerd score) and medication history; (2) medication reconciliation was conducted at admission to detect intentional and unintentional discrepancies in treatment; and (3) clinical medication review was carried out throughout the patient’s stay. The pharmacist conveyed proposed interventions to optimise treatment to the physician through the electronic health record. The number and type of PIs and their rate of implementation were recorded.ResultsIn total, 539 patients aged >65 years were included; their mean age was 84 years. Cognitive screening showed that 45% of patients were confused at admission. Medication adherence assessment indicated that 50.2% had adherence problems. Medication reconciliation at admission detected discrepancies in 48%, with a mean of 1.09 unintended discrepancies per patient. Patients were taking an average of 7 ± 3 drugs. In total, 828 PIs were reported to physicians; 520 were accepted and implemented (62.8% acceptance rate).ConclusionThis approach helps to avoid medication errors and enables the suggestion of relevant PIs, which were implemented by physicians in two-thirds of cases.

Protocolo da implantação do cuidado farmacêutico na geriatria: estratégia para segurança na assistência à saúde

“…Coleta dos dados subjetivos e objetivos: versando sobre os elementos da semiologia, empregou-se a anamnese constituída pelos dados sociodemográficos e antecedentes clínicos do paciente relativos ao uso de medicamentos (Figuras 2 e 3). Entretanto, previamente, um teste de orientação espaço-temporal (26) , que aborda memória recente e de longo prazo, foi aplicado no participante para garantir a fidedignidade dos relatos (Figuras 2 e 3). Dessa maneira, se o paciente respondesse corretamente no mínimo três das perguntas, foi considerado apto para relatar as informações requeridas.…”

Protocol for the implementation of pharmaceutical care in geriatrics: strategy for safety in health care

“…Collection of subjective and objective data: dealing with the elements of semiology, anamnesis was used, consisting of sociodemographic data and the patient's clinical history related to the use of medication (Figures 2 and 3). However, previously, a spatial-temporal orientation test (26) , which addresses short and long-term memory, was applied to the participant to ensure the reliability of the reports (Figures 2 and 3). Thus, if the patient correctly answered at least three of the questions, he was considered able to report the required information.…”

Key concepts in medication management in older persons for pharmacists practicing in non‐geriatric specialties

“…They can also contribute to functional assessment by identifying medications that may contribute to cognitive impairment, assessing medication-taking and adherence and performing basic cognitive screening. 30 Pharmacists may also utilise a patient's advance care plan to determine if the expected benefits of prescribed medications align with a patient's wishes and goals of care.…”

“…Evidence across multiple settings including oncology, acute geriatrics and day hospitals have shown positive medication-related outcomes when pharmacists are integrated into the multidisciplinary geriatric medicine team performing CGA, including increased identification of prescribing issues, reduction in polypharmacy, and a reduction in use of potentially inappropriate medicines (PIMs) and medication-related problems. 29,30,35…”