Appropriateness of medication prescribing in nursing homes: A collaboration project between pharmacy and geriatric departments |
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| Affiliation: | 1. Specialist Physician in Hospital Pharmacy, Department of Pharmacy, Hospital Universitario de Guadalajara, Spain;2. Specialist Physician in Geriatric Medicine, Department of Geriatrics, Hospital Universitario de Guadalajara, Spain;1. Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain;2. Department of Geriatrics Hospital Universitari Germans Trias i Pujol, Badalona, Spain;3. Department of Geriatrics Parc de Salut Mar, Barcelona, Spain;4. Departament of Geriatrics Hospital Vall d’Hebron, Barcelona, Spain;1. Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain;2. Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain;3. Geriatrics Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain;2. Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, España;3. Grupo de investigación REFiT Barcelona, Parc Sanitari Pere Virgili y Vall d’Hebron Institute of Research (VHIR);4. Estudios de Ciencias de la Salut y eHealth Center, Universitat Oberta de Catalunya;1. Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España;2. Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España;3. Sección de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España;1. Endocrine Division, Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil;2. Universidade Federal do Maranhão, Maranhão, Brazil;3. Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil;4. Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil;5. Brazilian Society of Cardiology, Brazil;6. Hospital Dante Pazzanese, São Paulo, Brazil;7. Sociedade Hospitalar Angelina Caron, Paraná, Brazil;8. Ambulatorio de Especialidades Maria Zelia, São Paulo, Brazil;9. Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil;10. Hospital Escola Alvaro Alvim, Rio de Janeiro, Brazil;11. Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil;12. Hospital Português, Pernambuco, Brazil;13. Research Institute of Heart Hospital (Hcor), São Paulo, Brazil;14. Heart Institute of University of São Paulo, Brazil;15. Universidade Nove de Julho (UNINOVE), São Paulo, Brazil;p. Hospital da Bahia, Bahia, Brazil |
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| Abstract: | PurposeTo evaluate the appropriateness of medication prescribing and to analyze interventions carried out in polymedicated elderly patients in nursing homes (NHs).MethodsProspective study of potentially inappropriate medication prescribing in polymedicated older adults living in NHs, implemented via a collaborative project between NHs and the geriatric and pharmacy departments of a university hospital. The pharmacist reviewed patients’ active medical prescriptions and prepared an individualized report with proposals aimed at therapeutic optimization that was sent for evaluation to the geriatrician in charge of the NH. The drug-related problems (DRPs) were classified according to the Third Consensus of Granada and the potentially inappropriate prescriptions (PIPs) were identified by explicit criteria (STOPP/START, BEERS, LESS-CHRON), implicit criteria (MAI) and CheckTheMeds® software. It was measured the degree of acceptance of the interventions carried out, and the economic impact was calculated from the direct costs of the discontinued drugs.ResultsOf the 210 patients reviewed by the pharmacy department, 105 patients from 10 NHs were analyzed. A total of 510 prescriptions with possible DRPs were identified (38.5% of all prescribed drugs). According to STOPP/START/BEERS or LESS-CHRON criteria, 41.2% were PIPs. The main DRPs identified were: unfavorable risk-benefit ratio, inappropriate dose/regimen, inappropriate treatment duration, probability of adverse events, medication not indicated, and duplicate therapy. Interventions were proposed for 81.5% of the DRPs detected, of which 73.3% were accepted. This resulted in a 23.1% reduction in the number of drugs prescribed per patient and an economic saving of €16,218 per 6-month period.ConclusionThe appropriateness of medication prescribing in polymedicated older adults living in NHs by the pharmacist has made it possible to reduce DRPs and PIPs and to save costs thanks to the high degree of acceptance by geriatricians. |
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| Keywords: | Potentially inappropriate prescribing Drug-related problems Elderly persons Multiple chronic conditions Nursing homes Prescripción potencialmente inapropriada Problemas relacionados con los medicamentos Pacientes mayores Pluripatológico Centros sociosanitarios |
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