Real-world assessment of drug related problems by medication reviews at the emergency department in older patients living with frailty

Abstract

Background Older patients are at risk of drug related problems (DRPs), potentially leading to emergency department (ED) visits. Identifying DRPs with medication reviews is typically evaluated in restrictive clinical studies and not in a ‘real-world’ setting with organizational challenges and time-pressure. This study aims to assess the number of DRPs at the ED in older patients living with frailty, and to determine the acceptance rate of medication recommendations among physicians and the general practitioner. Additionally, practical recommendations are provided for implementing a medication review program. Methods A retrospective observational study was performed in patients ≥ 70 years living with frailty who visited the ED at Tergooi Medical Center. Medication reviews were conducted to identify and classify DRPs as part of a larger geriatric assessment. Also, the acceptance rate of given recommendations was assessed. Results A total of 356 ED visits were included. The mean age of patients was 83 years. About 76% of patients had at least one DRP. In total, 548 DRPs were identified with a mean of 1.5 DRP per patient. The acceptance rate of medication recommendations in admitted patients was 55%, and 32% among general practitioners/elderly care specialists in discharged patients. Conclusions Our results show that medication reviews lead to better assessment of DRPs at the ED. The acceptance rate was substantially higher in admitted patients compared to discharged patients. Results of our study reflect the real-life setting of conducting medication reviews at the ED for older patients living with frailty.