Pharmacist intervention acceptance for the reduction of potentially inappropriate drug prescribing in acute psychiatry

Abstract

Background Prescribing for the elderly is challenging. A previous observational study conducted in our geriatric psychiatry admission unit (GPAU) using STOPP/START criteria showed a high number of potentially inappropriate drug prescriptions (PIDPs). A clinical pharmacist was added to our GPAU as a strategy to reduce PIDPs. Objective The objective of the present study was to assess the impact of a clinical pharmacist on PIDPs by measuring acceptance rates of pharmacist interventions (PhIs). Setting This study was conducted at the GPAU of Lausanne University Hospital. Method The clinical pharmacist attended four GPAU meetings weekly. Complete medication reviews were performed daily. The clinical pharmacist conducted standard analyses based on clinical judgment and STOPP/START criteria assessment. A PhI was generated when a PIDP was detected. When a PhI was accepted, the PIDP was considered as eliminated. Acceptance rate of PhI was calculated (number of PhI accepted/total number of PhI). Main outcome measure PhIs acceptance rates. Results In a cohort of 102 patients seen between July 2013 and February 2014, a total of 697 PhIs (average 6.8/patient) were made based on standard evaluation (n = 479) and STOPP/START criteria (n = 243). The global acceptance rate was 68% (standard, 78%; STOPP/START, 47%). Conclusion Good PhIs acceptance rates demonstrated that a clinical pharmacist can reduce PIDPs in a GPAU. PhIs based on standard evaluation had a higher acceptance than those based on STOPP/START criteria, probably because they are better adapted to individual patients. However, these two evaluation approaches can be used in a complementary manner.

Implementation of clinical pharmacy service in a tertiary psychiatric hospital in Aseer region, Saudi Arabia: 15 month experience.

“…This result indicated that the medical team rejection to the clinical pharmacist interventions has to be taken as a tool to improve educational and communication skills of clinical pharmacist and their interns. However, these results go well with the results from Hannou et al when they used two different techniques (STOP/START) where the total acceptance rate for clinical pharmacist ' s interventions was Implementation of clinical pharmacy service in a tertiary psychiatric hospital in Aseer region, Saudi Arabia: 15month experience 44% and 58% for STOP and START techniques respectively [12]. In the other hand, our improvement in response results will be comparable with the expectations of psychiatrists in Saudi Arabia toward clinical pharmacists when it has shown that 70% of psychiatrists see the clinical pharmacist as a reliable source of drug in neuropsychiatric field [26].…”

“…From the literatures, the acceptance rate of clinical pharmacist ' s interventions within psychiatric team showed optimism among clinicians where it was equal or more than 70% from either clinical pharmacists or clinical pharmacy residents [11,12].…”

Using Deprescribing Practices and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions Criteria to Reduce Harm and Preventable Adverse Drug Events in Older Adults

“…Hannou et al 31 introduced a part-time ward-based clinical pharmacist to a psychiatric unit’s multidisciplinary team and screened prescriptions for potentially inappropriate drug prescribing using the STOPP/START criteria. The intervention was measured by the acceptance rate of pharmacist interventions.…”

Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders

“…It extends the findings of Goldstone et al 21 and others [87][88][89] by highlighting recent work done by psychiatric pharmacists on patient-level outcomes. Many previous studies [90][91][92] describe the impact of pharmacist-performed comprehensive medication reviews and medication management services by highlighting only the number of drug-related problems identified or the number of pharmacist-suggested interventions accepted by the treatment team. Although useful, these findings do not measure the impact of the psychiatric pharmacist directly on patient outcomes, such as symptom control, quality of life, or need for hospitalization.…”