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

Abstract

ObjectivesOlder adults are a vulnerable and growing segment of the population with a high burden of comorbid conditions. As a consequence of increased co-morbidity, drug use in older adults is high, and polypharmacy has been linked to higher risk of adverse drug–drug interactions, morbidity, and mortality. The aim of the study was to evaluate the prevalence and nature of potentially inappropriate medications (PIMs) in a group of hospitalised older patients, and verify whether the use of ‘Beers criteria’ and/or ‘START & STOPP’ criteria could lead to deprescribing of drugs and reduce the length of stay in the hospital.MethodsTwo hundred acutely ill patients aged ≥65 with multimorbidity admitted to the Division of Internal Medicine were enrolled in the study. Enrolled patients were admitted as medical emergencies and observed during their hospitalisation at the Emergency Department and subsequently at the Division of Internal Medicine. The pharmacological treatments taken by patients at home, during hospitalisation and at discharge, were examined, identifying inappropriate prescriptions (IPs), according to ‘Beers criteria’ and ‘START and STOPP’ criteria.ResultsThere were 487 IPs: 175 according to the Beers criteria; 50 according to the STOPP criteria; one according to the START criteria; 107 major interactions; 152 minor interactions; one off-label drug; and one duplicated pharmacotherapy. Twenty-three adverse drug reactions (ADRs) were recorded: the most frequent were abnormalities of serum electrolytes (35%); haemorrhagic events (22%); and accidental falls from benzodiazepine use (9%). The correct application of these criteria decreased IPs by 38% and reduced the number of drugs prescribed by the physician during the stay in the medical ward and at discharge by 19%.ConclusionsThe use of criteria that detect IPs reduced PIMs and ADRs, increased safety in older patients, and reduced the number of drugs prescribed but did not reduce the length of stay in hospital.

Identification of Barriers for Active Disease Management and of Medication-Related Problems through Therapeutic Patient Education in Older Home-Care Patients

“…These are preventable PIPs that are already included in validated recommendations and guidelines for prescribing medications in older patients, which, although they do not have a high risk of causing serious adverse reactions, could cause side effects and make the therapy more complex and difficult to manage. These results are consistent with other studies that included an evaluation of the prescriptive appropriateness of chronic pharmacological therapies [36,37]. This underlines the importance of involving a drug expert, such as a pharmacist or a researcher on drug utilization, in the patient care pathway: although some of the evidence [40][41][42][43][44] associated the presence of a drug expert with positive health outcomes, this figure is still not systematically involved in clinical practice at a national level.…”

“…Although the degree of complexity among the enrolled patients is not known (it is beyond the scope of this study), it can be assumed that they present varying degrees of complexity related to the presence of comorbidities and polypharmacy, in line with the fact that they were accepted by the home-care service. As many studies have shown [35][36][37][38][39], the results of the medication review confirmed the presence of medication-related problems and PIPs in the therapies of older chronic patients, highlighting the importance of periodic re-evaluations of prescribed medications or of a medication review during transitions of care to improve the concordance between patient and GP. The most frequently identified PIPs according to both the Beers and the STOPP criteria were ibuprofen, furosemide, pantoprazole and rivaroxaban.…”

Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians’ experience and a review of patient records

“…However, almost 90% of patients with hip fracture had at least one fall-risk-increasing drug prescribed prior to falling 25. Medication review may help patients reduce the number of potentially inappropriate medications (PIMs)26 27—including fall-risk-increasing drugs25—subsequently the risk of ADRs28–30 and medication-related rehospitalisation 7 31…”

Interactions between prescription drugs in hospitalized geriatric patients

“…Medication errors are any preventable incident that can lead to inappropriate use of them 8 . At present, drug interactions may increase morbimortality in patients by decreasing the effectiveness of treatment or causing adverse events 9 .…”