Evaluation of a collaborative care approach between general practitioners and clinical pharmacists in primary care community settings in elderly patients on polypharmacy in Slovenia: a cohort retrospective study reveals positive evidence for implementation

Štuhec, Matej; Gorenc, Katja; Zelko, Erika

doi:10.1186/s12913-019-3942-3

Cited by 50 publications

(85 citation statements)

References 28 publications

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“…GP acceptance of at least one HMR recommendation at three months after discharge was 68%, and this was higher than an observational study in primary care (n = 91) in which GP acceptance of 304/625 pharmacist recommendations (48%) was reported [13], and a study (n = 1021) reporting GP acceptance of ED pharmacist recommendations (49%) [23].…”

Section: Discussionmentioning

confidence: 62%

“…Medication reconciliation at admission and discharge increased signi cantly in the intervention site in phase two in this study. Medication review has been reported to signi cantly improve the appropriateness of prescribing in aged care facilities [14,15] and primary health care [13].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported the effect of interventions on medication safety for older people in the community or primary care settings [12][13][14][15], however this study evaluated the effectiveness of a pharmacist intervention for PWD inpatients and the effect on polypharmacy and PIMS. Medication safety for PWD is particularly important because of the risks associated with medications for PWD.…”

Section: Discussionmentioning

confidence: 99%

“…Where it is possible to reduce medications, the risk for PWD is also reduced. Some previous intervention studies have been conducted to reduce PIMs in community/primary care settings [12][13][14] and nursing homes, for older people [15]; however no studies have been conducted in hospital settings or on PWD for this purpose. Previous studies of older people in non-hospital settings used interventions such as education interventions, medication reviews and collaborative care approaches.…”

Section: Introductionmentioning

confidence: 99%

“…An intervention study involving hospital pharmacists completing the medication management plan in the medical discharge summary also reported a signi cant reduction in the rate of medication errors at discharge [17]. Furthermore, a study that evaluated a collaborative care approach involving clinical pharmacist medication review, in which the clinical pharmacist was based in the community health centre with the general practitioner (GP); reported that 48% of recommendations were accepted by GPs in an elderly community population (n = 91) [13]. The results of these previous studies suggest that it is important to undertake research to evaluate the effectiveness of pharmacist interventions for PWD in the acute care setting to reduce PIMs (and associated anticholinergic burden), and polypharmacy and measure the frequency of medication prescribing errors for these vulnerable admitted patients.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Effect of an Intervention on Potentially Inappropriate Medications (PIMS), Polypharmacy and Anticholinergic Burden Scores for People with Dementia; Results from the SMS Dementia Study†: A Quasi-Experimental Study

Kable¹,

Fraser

Fullerton

et al. 2020

Preprint

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Background People with dementia (PWD) are at risk for medication related harm due to their impaired cognition and frequently being prescribed many medications. Few previous studies of PWD inpatients have been focused on medication safety interventions.This study aimed to evaluate an intervention designed to improve medication safety for people with dementia (PWD) and their carers during an unplanned admission to hospital. This article reports the effect of the intervention on potentially inappropriate medications (PIMs), polypharmacy and anticholinergic burden scores for PWD in the study. Methods A quasi-experimental pre-post design using an intervention site and a control site was conducted in 2017-2019, in a regional area in New South Wales, Australia. PIMs, polypharmacy and anticholinergic burden were measured at admission, discharge and three months after discharge. In addition, medication reconciliation at admission and scoring of pharmacists recommendations using severity and relevance scores were measured. Results There were 628 participants including 350 in the post-intervention phase. Polypharmacy for these admissions was high, and there was approximately 30% reduction in the number of medications at discharge. PIMs at admission were also high, and decreased significantly at discharge however there was no treatment effect associated with the intervention. The mean anticholinergic burden score also decreased significantly between admission and discharge, however, no treatment effect was seen. Conclusions High rates of polypharmacy and PIMs in this study indicate this study population was admitted with multiple comorbidities. Reduced PIMs at discharge were correlated with reduced anticholinergic burden. Medication reconciliation resulted in many recommendations that contributed to the reductions in medications. Although the study did not report a treatment effect, reductions in the number of medications and PIMs reduced medication related risk for PWD. Reduced risks associated with inappropriate or unnecessary medications can reduce hospital admissions and adverse events for PWD. This intervention was feasible to implement, and future multisite studies should be designed to recruit larger study samples to evaluate interventions for improving medication safety for PWD. They should also adopt routine screening for cognitive impairment to identify PWD at admission.

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Section: Discussionmentioning

confidence: 62%