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

Abstract

Background: In this study, an intensive review of pharmaceutical care for elderly patients was conducted in a Veterans Administration nursing home in Taiwan and its effects were evaluated. Methods: One hundred participants were enrolled in this randomized controlled study with even distribution. The inclusion criteria were age 65 years or older, prescriptions for at least 5 oral medicines daily, and ≥2 chronic diseases, for the period May 2013 to October 2014. Subjects were excluded if they had previously been included in an intensive medication review conducted by a pharmacist. The primary outcomes were numbers of drugs prescribed, potential inappropriate medications, and numbers of drug-related problems. The secondary outcomes were self-reported medical usages, measurements of quality of life, results of a satisfaction survey, and health status. Results: A total of 80 cases (42 in the intervention group with medication reconciliation and 38 in the control group without medication reconciliation) completed the study. Baseline characteristics were not statistically different between the 2 groups. The overall prevalence of potential inappropriate medication was 74.3%. There were no differences between the 2 groups, with the exception of “medical problems,” which showed a significantly higher prevalence in the intervention group ( P < .05). The intervention group reported greater satisfaction regarding pharmacist visits and medication compliance ( P < .01). The mean number of drug-related problems was significantly lower after the intervention ( P < .01). Conclusion: In this study, the intensive review of the elderly patients’ medications revealed that the only significant effect of pharmaceutical care was on “all outcomes.” A possible reason for this is the rather advanced ages of some patients who needed a considerable number of medications to treat several chronic diseases. Another reason may be the small sample size. However, participants who received the pharmacist intervention did have higher satisfaction with medication reconciliation and fewer drug-related problems.

The pharmacists’ interventions after a Drug and Therapeutics Committee (DTC) establishment during the COVID-19 pandemic

“…There was no significant statistical difference between the number of prescribed medications pre- and post-intervention, in line with a previous study (Liou et al, 2021 ). Expenditures were measured by comparing medication costs before and after the implementation of the intervention, in line with a previous study (Beardsley et al, 2012 ).…”

“…Stewardship strategies can save antibiotic medication costs (Malani et al, 2013 ; Nowak et al, 2012 ), in line with our study. However, some previous studies failed to demonstrate a significant healthcare resources reduction (Al-Hashar et al, 2018 ; Cypes et al, 2021 ; Liou et al, 2021 ). Even with fewer resources and supports and no dedicated pharmacist time, our DTC-trained clinical pharmacists-led antimicrobial stewardship interventions have produced significant reductions in antimicrobial use and expenditures, in line with a previous study with limited resources (Malani et al, 2013 ).…”

Inappropriate polypharmacy management versus deprescribing: A review on their relationship

“…• It may also contain the use of screening tools and advanced training to help identify medication inappropriateness. [15][16][17] Pharmacist, with or without collaboration with other healthcare providers…”

Situación legal de la atención farmacéutica en residencias de ancianos en España

“…Otro de los grandes problemas que sufren los pacientes ancianos polimedicados es la prescripción inadecuada (8) , que tiene como consecuencia una mayor morbilidad y un aumento del gasto en recursos sanitarios (9) . La revisión periódica de la medicación parece ser la herramienta clave para prevenir estos problemas y las reacciones adversas que producen (10) , a través de la intervención del farmacéutico en los centros sociosanitarios (11) , cuya actuación a través de los servicios de farmacia (SF) conlleva a una reducción de la tasa de mortalidad (12,13) , del número de caídas (14,15) y de las hospitalizaciones (12,16) .…”