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Appropriateness of Prescribing among Elderly Patients in a Dutch Residential Home

Observational Study of Outcomes after a Pharmacist-Led Medication Review

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Abstract

Background: Clinically significant pharmacokinetic and pharmacodynamic changes occurring with age make older patients more prone to the consequences of inappropriate prescribing. The combination of higher use of medicines resulting from a higher disease burden with suboptimal treatment monitoring results in a higher risk of unwanted drug effects from sometimes inappropriate choice of drugs, doses and durations of treatment. Pharmacy services are increasingly being targeted to minimize the overall number of unnecessary and potential harmful medicines.

Objective: To investigate the impact of a pharmacist-led medication review on quality of prescribing by a healthcare professional team consisting of a general practitioner (GP), care home staff and a pharmacist.

Methods: This observational study compared outcome measurements before and after a pharmacist-led review of medications for patients under the care of a healthcare professional team consisting of a GP, care home staff and pharmacist. The procedure for conducting and recording the medication review consisted of the preparation of a patient medication profile, which combined the patient’s medical records with his or her complete prescription record (current and previous [last 3 years] medication history) and pharmaceutical record (electronic journal entries for the patient over the same period). Laboratory values were evaluated in clinical context. Recommendations for the pharmaceutical plan were discussed at a conference involving the clinical pharmacist and other healthcare team members. Patients were recruited for medication review over the 12-month period 1 April 2003 to 1 April 2004. Medication appropriateness was assessed by an independent panel of clinical pharmacists using the Medication Appropriateness Index (MAI).

Results: A total of 54 patients were eligible according to the inclusion criteria, of whom 24 were subsequently excluded for various reasons; thus, 30 patients were eligible for assessment on the MAI. There was a statistically significant difference between overall pre- and post-intervention summed MAI scores (p = 0.013). The pharmacist identified 115 drug-related problems, and the total number of accepted recommendations was 78 (67.8%). Use of a medication review as an intervention by a clinical pharmacist was associated with an improvement in appropriateness of prescribing.

Conclusion: This study provides evidence supporting the formal integration of a clinical pharmacist into the healthcare team with the aim of improving prescribing appropriateness for institutionalized elderly Dutch patients. Overall MAI scores for all long-term medications used by a group of elderly patients improved significantly after a pharmacist-led medication review. This is an important finding because quality of prescribing is assuming increasing importance as a means of preventing avoidable medication-related harm.

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Acknowledgements

The main local insurance company, PWZ/Achmea, compensated participating general practitioners financially for time spent on the study but had no influence on the study design, method subject recruitment or data. No sources of funding were used to assist in the preparation of this manuscript.

C.C.M. Stuijt would like to express her sincere gratitude to all supporting hospital and community pharmacists from the Onze Lieve Vrouwe Gasthuis (E.J.F. Franssen, C.T.M. van der Linden, E.A.F. Haak, G.K.K.E. Thio, M.E. Attema-de Jonge, M.J.H.A. Vanenburg, K.D. Yap, E.L. Sanders) and the Academic Medical Centre in Amsterdam (R.A.J. Kuiper and S.M. Smorenburg) and Ijsselmeerziekenhuizen (Almere and Lelystad) [J. Dijkstra and P.A.M.M. Boermans], all of whom donated an invaluable number of private hours to the scoring of the Medication Appropriateness Index.

The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Department of Pharmacy, Onze Lieve Vrouwe Gasthuis, Michelangelostraat 62-2, 1077CG, Amsterdam, the Netherlands

    Clementine C. M. Stuijt & Eric J. F. Franssen

  2. Department of Clinical Pharmacy, University Medical Centre, Utrecht, the Netherlands

    Antoine C. G. Egberts

  3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands

    Antoine C. G. Egberts

  4. Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK

    Steve A. Hudson

Authors
  1. Clementine C. M. Stuijt
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  2. Eric J. F. Franssen
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  3. Antoine C. G. Egberts
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  4. Steve A. Hudson
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Correspondence to Clementine C. M. Stuijt.

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Stuijt, C.C.M., Franssen, E.J.F., Egberts, A.C.G. et al. Appropriateness of Prescribing among Elderly Patients in a Dutch Residential Home. Drugs Aging 25, 947–954 (2008). https://doi.org/10.2165/0002512-200825110-00005

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  • DOI: https://doi.org/10.2165/0002512-200825110-00005

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