Background Evidence concerning the relevance of screening tools to reduce inappropriate prescribing is scarce and existing tools were only partially effective in our geriatric population. Hence, we developed and validated the RASP list (Rationalisation of home medication by an Adjusted STOPP list in older Patients), a novel instrument to reduce polypharmacy in the geriatric population.
Purpose To determine the efficacy and safety of the RASP list in elderly inpatients.
Materials and methods In a monocentric cluster-randomised controlled trial, patients were randomly assigned to an intervention or a control arm. All community-dwelling elderly admitted to the geriatric ward were eligible. The intervention consisted of a pharmaceutical care plan, which was based on but not limited to the RASP list. In the intervention group, all recommendations were discussed with the treating geriatrician, while the control group received standard care. Co-primary endpoints were the number of stopped/reduced drugs and the actual number of drugs at discharge. Secondary endpoints included the number of falls, readmissions (total and emergency department), and mortality during the 3 month follow-up.
Results 172 patients were included in the analysis (intervention: 91, control: 81). At discharge significantly more drugs were stopped or reduced in dosing in the intervention (47.4%) compared to the control (34%) group (p < 0.0001). The absolute number of drugs at discharge decreased by an average of 14.6%, after correction for de novo calcium and vitamin D treatment, which was started more frequently in the intervention group. The number of drug intakes decreased significantly in the intervention group, regardless of calcium/vitamin D intake. There was no difference in the rate of falls, readmissions or mortality, although numerically less emergency department readmissions were noted in the intervention group (20% vs 29%).
Conclusions The RASP list significantly reduced polypharmacy in geriatric inpatients compared to standard geriatric care, without increasing harm. More drugs were stopped or reduced in the intervention arm, resulting in a lower number of drugs and drug intakes at discharge.
No conflict of interest.
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