Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly

Schmader, Kenneth E.; Hanlon, Joseph T.; Pieper, Carl F.; Sloane, Richard; Ruby, Christine M.; Twersky, Jack; Francis, Susan Dove; Branch, Laurence G.; Lindblad, Catherine I.; Artz, Margaret B.; Weinberger, Morris; Feussner, John R.; Cohen, Harvey Jay

doi:10.1016/j.amjmed.2003.10.031

Cited by 281 publications

(228 citation statements)

References 33 publications

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“…In agreement with these results, a previous study showed a reduction in the number of drugs with at least one inappropriate rating after implementation of the LIMM model [10]. A number of earlier controlled studies on pharmaceutical care, integrated medicines management or other collaborative approaches in hospitalised patients have also shown improvements in the appropriateness of medications (decrease in the MAI scores) [9,28,29].…”

Section: Discussionsupporting

confidence: 73%

“…Nonetheless, we have presented the MAI scores in this study in order to facilitate comparison with previous studies. In our study, the average patient MAI score in the intervention group at discharge was lower than that in most other studies (indicating more appropriate prescribing) [9,10,28,29]. However, because the control group also had a very low patient MAI score, there were no apparent differences between the groups.…”

Section: Discussioncontrasting

confidence: 53%

“…However, because the control group also had a very low patient MAI score, there were no apparent differences between the groups. In two previous interventions with a similar lack of improvement in the MAI scores [29,31] neither the intervention nor the control group improved.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Hellström

Bondesson

Höglund

et al. 2011

Eur J Clin Pharmacol

135

164

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The study was funded by Apoteket AB and the County of Skåne, Sweden. Abstract PurposeTo examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drugrelated hospital revisits in elderly patients. MethodsThis was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management (LIMM) model (medication reconciliation at admission and discharge, and medication reviews and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation at discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria). ResultsThere was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population (51% [95% CI 43-58%] versus 39% [95% CI 30-48%], p=0.0446) and the per-protocol population (60% [95% CI 51-67%] versus 44% [95% CI 34-2 52 %], p=0.0106). There were 6 revisits to hospital in the intervention group which were judged as 'possibly, probably or certainly drug-related', compared with 12 in the control group (p=0.0469). ConclusionIn this study, medication reconciliation and reviews provided by a clinical pharmacist in a multiprofessional team significantly reduced the number of inappropriate drugs and unscheduled drugrelated hospital revisits among elderly patients.

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Section: Discussionsupporting

confidence: 73%

Section: Discussioncontrasting

confidence: 53%

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Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Hellström

Bondesson

Höglund

et al. 2011

Eur J Clin Pharmacol

135

164

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“…Interdisciplinary geriatric evaluation and management in frail elderly resulted in a 35% reduction in the risk of severe ADRs compared with usual care in ambulatory older adults. 52 Investigators also reported a significant reduction in inappropriate drug use and underuse in ambulatory older adults. Pharmacists providing inpatient drug review services can improve the quality of pharmaceutical care and possibly reduce the total cost of therapy.…”

Section: Interdisciplinary Team Carementioning

confidence: 99%

“…Inpatient geriatric unit care reduces unnecessary and inappropriate drug use and underuse, improves suboptimal prescribing, 52 and reduces mortality. 53 The team pharmacist usually is responsible for ensuring appropriate drug therapy for prevention and treatment; monitoring drug use; identifying and resolving adverse drug reactions (ADRs) or drug-related problems; and providing drug education to health care providers, patients, and caregivers.…”

Section: Interdisciplinary Team Carementioning

confidence: 99%

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

et al. 2005

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In the United States, older adults have become the fastest growing segment of the population and are expected to double in number to 70 million by 2030. As a whole, older adults have different health care needs than younger patients, and some of these needs should be met by pharmacists. Clinical pharmacy practice affecting older adults occurs in a variety of settings, including community, ambulatory care, primary care, hospital, assisted living, nursing home, home health care, hospice, and Alzheimer's disease units. Although specialty training in geriatrics or gerontology is not required for pharmacists to care for older adults, it is extremely helpful. Pharmacy education related to the care of older adults has improved slightly in the past several years but will need to increase even more to provide all pharmacists with the basic skills and knowledge to care for this unique group of patients. In addition, pharmacotherapy research targeting older adults needs to increase. Although it can be challenging, funding for this type of research is available. Patient and political advocacy is also important to support this growing population.

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Time to Change the Paradigm—From “Potentially Inappropriate” to Real Patient Harms

Shehab¹

2011

Arch Intern Med

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sidered in this study and matching our inclusion criteria were included in our work, further indicating that our metaanalysis does not carry any selection bias.With regard to the specific trials suggested by Nakao and colleaguesintheirletter,webelievethattheydonotfitoursearch and appropriateness criteria, and thus they were not considered. The purpose of our analysis, in fact, was to specifically analyze the impact of different antihypertensive therapies on the prevention of HF. In the HIJ-CREATE study, 4 only subjects with angiographic evidence of coronary artery disease were enrolled,resultinginaprevalenceofHFattheenrollmentaround the 20%, with no provided information about the hemodynamic status and the specific therapy of subjects with HF. In the CASE-J 5 and KYOTO-HEART study, 6 subjects with pre-existing HF werealsoenrolledandnoinformationabouttheirhemodynamic status and their specific treatment for HF were provided. In the CASE-J study, the prevalence of subjects with pre-existing HF in the 2 arms of treatment is not known.On the other hand, in the Jikey Heart study, 7 which was considered in our analysis, and which also included a proportion of subjects with baseline HF, these patients were enrolled only if they had been stabilized receiving a standard therapy for HF for at least 1 month. In addition, the percentage of baseline HF was exactly the same in the 2 arms of treatment.On the basis of these considerations, we still believe that the inclusion of these trials in our analysis, rather than their exclusion would have represented a potential source of bias. In any event, even including the results of these trials, this would lend negligible impact on the results of our meta-analysis.With regard to the letter of Elliott and colleagues, we appreciated the fact that the results and conclusions of our article are fully supported by their analysis. In their letter, these authors confirm that diuretics and angiotension-converting enzyme inhibitors are the most effective classes of antihypertensive drugs in the prevention of HF. The hypothesis that chlorthalidone is superior to the other diuretics is intriguing, although many factors should be taken into consideration before drawing final conclusions. First of all, the dosage of other diuretics, mostly thiazides, is hardly comparable to the dose of chlorthalidone in most of the studies. In addition, chlorthalidone was used in much larger and long-term studies. Indeed, the trend of a superior effect of chlorthalidone compared with "other diuretics" is only linked to indirect comparisons and influenced by the inclusion of the results of trials conducted more than 3 decades ago, which may not reflect current clinical hypertension management. Obviously, as meta-analyses generate hypotheses, it would be strongly desirable to perform a head-to-head comparison between chlorthalidone and other diuretics to clarify this issue. Our current study 1 cannot address this problem because we did not perform intraclass comparisons in view of the high risk to miss a sufficient...

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Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly

Cited by 281 publications

References 33 publications

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

Time to Change the Paradigm—From “Potentially Inappropriate” to Real Patient Harms

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