Medication review versus usual care to improve drug therapies in older inpatients not admitted to geriatric wards: a quasi-experimental study (RASP-IGCT)

Abstract

BackgroundInterdisciplinary geriatric consultation teams (IGCT) are regularly requested to provide comprehensive geriatric assessments in older inpatients. Our primary aim was to evaluate whether medication reviews increased the number of IGCT-provided drug-related recommendations. Secondary aims were to reduce the number of potentially inappropriate medications (PIMs), and to identify the acceptance rate of and determinants for the number of recommendations.MethodsA before-after study was performed in older inpatients not admitted to acute geriatric wards. The before cohort received usual care (UC); the after cohort was subjected to the intervention (I), consisting of a systematic medication review, based on but not limited to the RASP (Rationalization of Home Medication by an Adjusted STOPP in Older Patients) list. The primary outcome measure was the number of IGCT-provided drug-related recommendations. Age, sex, Charlson Comorbidity Index, creatinine clearance and serum creatinine were ascertained upon enrolment. Following variables were determined on admission and at discharge: number of drugs and number as well as type of RASP-identified PIMs. Acceptance by ward-based physicians was also determined. Poisson regression was performed to identify determinants for the primary outcome measure.ResultsFifty-nine participants were enrolled (nUC = 29; nI = 30). The intervention increased the number of drug-related recommendations from a median of 0 (IQR: 0–1) to 8 (IQR: 6.75–10) (p < 0.001). The median number of accepted recommendations differed significantly as well (UC vs. I: 0.0 (0.0–0.5) vs. 3.0 (0.0–5.3); p < 0.001). In the intervention cohort, patients were discharged with fewer drugs compared to admission (UC vs. I: 108.5%, IQR: 100.0–135.8% vs. 92%, IQR: 80.5–103.5%; p = 0.002). More RASP PIMs were discontinued in the intervention cohort, with a mean difference of 1.49 RASP PIMs (95% confidence interval (CI): 0.70, 2.23; p < 0.001). Regression analysis identified two determinants: allocation to the intervention cohort with an incidence rate ratio (IRR) of 14.1 (95% CI: 8.30, 23.8) and the number of preadmission drugs with an IRR of 1.06 (95% CI: 1.03, 1.09).ConclusionsA structured medication review as part of usual IGCT care may contribute to an increased detection of drug-related problems and help to further reduce polypharmacy in older inpatients, not admitted to acute geriatric care wards.Trial registrationNCT02165618, retrospectively registered June 17, 2014.

Medication review versus usual care to improve drug therapies in hospitalised older patients admitted to internal medicine wards

“…In the best hospital setting an interdisciplinary geriatric consultation team (IGCT), with physicians of various medical specialties, nurses, dieticians, and pharmacists, is regularly provided to ensure comprehensive geriatric assessments in older inpatients. A Belgian study demonstrated that a structured medication review as part of usual IGCT care may contribute to an increased detection of drug-related problems and help to further reduce polypharmacy in older inpatients 19. Coleman et al demonstrated that by improving transitions of care through visits with a care team that included physicians, nurses, and pharmacists the number of Emergency Department visits was reduced 20 21.…”

<p>Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study</p>

“…5,[11][12][13][14][15][16][17][18] Studies from inpatient settings have also shown that including a pharmacist as a member of the interdisciplinary health care team may improve outcomes and decrease drug-related readmissions and mortality in geriatric patients. 2,17,[19][20][21] As team members, pharmacists offer an additional perspective in the application of medication reviews, resulting in an increase in detection of DRPs and a reduction of polypharmacy in elderly inpatients. 21 Pharmaceutical care, described as the pharmacist's contribution to the care of individuals in order to optimize medicines use and improve health outcomes, is the foundation of clinical pharmacy.…”

“…2,17,[19][20][21] As team members, pharmacists offer an additional perspective in the application of medication reviews, resulting in an increase in detection of DRPs and a reduction of polypharmacy in elderly inpatients. 21 Pharmaceutical care, described as the pharmacist's contribution to the care of individuals in order to optimize medicines use and improve health outcomes, is the foundation of clinical pharmacy. In the past decade, changes in pharmacy undergraduate education and new legislations in the Turkish health care system have indicated increasing recognition of the pharmaceutical care practice.…”

Medicine optimization strategy in an acute geriatric unit: The pharmacist in the geriatric team

“…However, in a previous retrospective study carried out in the same AGU, a reduction in the prevalence of polypharmacy or inappropriate prescriptions between admission and discharge with usual care was not found . This suggests that more specific interventions could enhance the outcomes of the CGA regarding medications . Interventions have been proposed elsewhere for medicine optimization in hospitalized older people, with different results .…”

“…Interventions must be adapted to the settings and patients’ needs. The best results in improving important health outcomes, such as readmissions or emergency room visits, have been shown in multifaceted multidisciplinary interventions . Pharmacists having extensive knowledge of medications can be valuable for this purpose, and the combination of a specific strategy in acute geriatric specialized care can be the answer to this problem .…”