Effect of Pharmacist Intervention on a Population in Taiwan with High Healthcare Utilization and Excessive Polypharmacy

Abstract

Patients with high healthcare utilization are at increased risk of polypharmacy and drug interactions. This study investigated the changes in the number of medications, drug interactions and interaction severity in high frequency outpatients with polypharmacy at hospitals and clinics in Taiwan after home pharmaceutical care, to understand the effectiveness of interventions by pharmacists. This was a retrospective observational study. Cases with excessive polypharmacy (10+ drugs) were selected from the Pharmaceutical Care Practice System database of the Taiwan Pharmacist Association in 2017. After the home care intervention, the number of drug types used decreased 1.89-fold (p < 0.001), and the number of medications fell 61.6%. The incidence of drug interaction was 93.82%. In an average case, the incidence of drug interaction after the pharmacist intervention decreased 0.6-fold (p < 0.001). The drug most commonly causing interactions was aspirin, followed by diclofenac; also common were three used in diabetes, two psycholeptics and two beta blockers. Among 22 cases of severe drug interaction, seven resulted in increased risk of extrapyramidal symptoms and neuroleptic malignant syndrome. By analyzing the relationship between the side effects of individual drugs and the pharmacokinetic Tmax, a sequential thermal zone model of adverse drug reactions can be established, the value of which could prompt physicians and pharmacists to intervene in order to prevent adverse events. It is concluded that home pharmaceutical care by pharmacists can significantly reduce the number of medications and interactions in patients with excessive polypharmacy and high healthcare utilization.

The performance of the clinical pharmacist in pharmaceutical care and intervention in cases of polymedicated elderly people: an integrative review

“…About IP, studies such as that of Wang et al, (2019), who investigated, through an observational study, changes in the amounts of medication in polymedicated elderly people after intervention and pharmaceutical follow-up, were able to show that before the PI, there were 2,874 cases (95.9%) of drug interactions due to polypharmacy and after the PI, around 287 cases used fewer types of medication, representing 61.6% of the total number of cases. In addition to 572 fewer drug interactions, a decrease of 19.90%.…”

The Impact of Pharmaceutical Home Care on Medical Utilization for Frequent Users of Outpatient Services in Taiwan

“…Pharmaceutical care has evolved from passively waiting for patients in the past and has now developed into an active provision of services, and community pharmaceutical care has also become a trend [ 11 ]. Several positive outcomes obtained with different pharmaceutical care programs are making a beneficial change based on the pharmacist’s professional judgment by applying continuous quality improvement [ 12 ]. This plan is the first time that a community pharmacist provides pharmaceutical care for patients with frequent visits.…”

Potentially Inappropriate Medication among Older Patients Who Are Frequent Users of Outpatient Services

“…The experimental group had high rates of utilization of medication and were frequent users of outpatient services, while the control group were not. The experimental group consisted of patients who had attended more than 90 consultations in hospital outpatient services or general practitioner clinics in the previous year, and were either being treated for more than two types of chronic diseases or had been prescribed five or more drugs in more than half of their prescriptions in the previous year [26].…”