Background One of the main causes of injuries and hospital admissions in older people is falls. The risk of falling can be increased by factors such as vision and balance problems, dementia and drug consumption. In 2012, pharmacists in primary care performed an intervention, providing physicians with a list of elderly outpatients who were candidates for a clinical review because potentially inappropriate prescriptions (PIP) for sedative effect drugs was detected.
Purpose To evaluate the impact of pharmacist interventions in health outcomes of elderly patients receiving polypharmacy.
Material and methods Retrospective study at 10 primary care centres, which included polypharmacy outpatients, older than 65 years, whose pharmaceutical interventions (PI) were made in 2012 because of a PIP for sedative drugs. We evaluated acceptance by physicians checking the prescribing modifications of the pharmaceutical recommendations. We then analysed health outcomes in patients whose doctor had withdrawn the sedative effect drugs and patients without modifications in their treatment, reviewing the clinical history for a 12 month period after the intervention.
Results 234 PI were included. Mean patient age was 77 (±7) years. 2 of 5 patients had suffered adverse events from sedative drugs before the PI, 42% were classified as at risk of falling. The drugs involved were: tricyclic antidepressants (46%), first generation antihistamines (33%), first generation antipsychotics (16%) and 3 benzodiazepines concurrently (5%). Acceptance rate by physicians of pharmacist recommendations was 33%. We detected that 16% of patients had suffered at least one fall during the year after the intervention, of whom in 76% of cases the physician did not accept the pharmacist’s recommendation and patients had no changes in their medication, although we found no significant difference between the two groups. The falls in this group generated 15 primary care visits, 30 emergency visits and 3 hospital admissions.
Conclusion An appropriate use of sedative drugs in the elderly population could contribute to a reduction in the risk of falling and fall related injuries. A higher frequency of adverse events was found in patients without changes in their medication, as recommended by pharmacists, although future research is necessary to confirm whether these interventions are useful in reducing negative health outcomes and changing prescribing habits.
References and/or Acknowledgements Thanks for your help to Dr Sam Ramsay.
No conflict of interest.
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