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Prescription of potentially inappropriate drugs for geriatric patients in long-term care: improvement through pharmacist's intervention
  1. Conxita Mestres1,
  2. Anna Agustí2,
  3. Laura Puerta3,
  4. Montse Barba4
  1. 1Department of Pharmacy, Grup Mutuam, Barcelona, Spain
  2. 2Department of Pharmacy, HSS Mutuam Girona, Girona, Spain
  3. 3Department of Pharmacy, HSS Mutuam Güell, Barcelona, Spain
  4. 4Department of Pharmacy, Primary Care, Barcelona, Spain
  1. Correspondence to Conxita Mestres, Pharmacy Director, Grup Mutuam, Mare de Deu de la Salut 49, Barcelona 08024, Spain; conxita.mestres{at}mutuam.com

Abstract

Objectives To determine the prevalence of potentially inappropriate prescribing in our long-term care institutions with limited experience of pharmacists’ interventions. To apply preventative measures, based on pharmacists’ recommendations, to obtain better outcomes for our patients.

Methods Patients were aged >75 years. The study consisted of a retrospective assessment of the prescription of these drugs (July–December 2010: 600 patients), an educational and informative programme to physicians (2011), followed by application of pharmacists’ recommendations (March–November 2012: 1048 patients), based on Beers criteria.

Results In the retrospective period, at least one potentially inappropriate drug was prescribed for 19% of patients. Patients receiving temporary care for long-term disease (temporary long-term care) and continuing long-term care (LTC) were prescribed a higher proportion of potentially inappropriate drugs (46.5% and 36.0%, respectively). During the intervention period inappropriate drug prescription dropped to 14.5%. Physicians ‘acceptance of the recommendations made by pharmacists’ was 45.5%. Acceptance was lower in temporary LTC and subacute care. Fourteen different potentially inappropriate drugs were prescribed in both periods. Amiodarone and hydroxyzine are among the drugs which are more difficult to change.

Conclusions Revision of treatments by pharmacists and their subsequent recommendations to physicians improves the quality of treatments. Physicians are now more aware of the importance of pharmacists’ interventions and a new stage of wider interventions and recommendations has begun. An algorithm has been established that standardises pharmacist interventions and leads to continuing improvement.

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