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CP-084 Pharmacist identification of potential side effects in patients with multimorbidity and polypharmacy
  1. L Jeffery,
  2. MG Kruse
  1. Silkeborg Regional Hospital, Viborg Hospital Pharmacy, Silkeborg, Denmark


Background Denmark’s first outpatient clinic for multimorbidity and polypharmacy opened at Silkeborg Regional Hospital in 2012. The clinic treats patients with at least 2 chronic illnesses, who present with a variety of symptoms. The pharmacist is an integral member of the multidisciplinary team that sees the patient during a single visit. The team includes a nurse, medical consultant, physio- and occupational therapist, and relevant senior doctors from 9 other medical specialities, including psychiatry.

Purpose To document the impact of a pharmacist on identification of potential side effects to regular medicines and on other medicines-related problems (MRP) in patients at a clinic for patients with multimorbidity.

Materials and methods Before the patient sees the consultant, the pharmacist interviews the patient about all aspects of his medicines history (including over the counter medicines and herbal/natural medicines) and updates the electronic prescribing system. A full medicines review is then carried out with extra focus on possible side effects. The pharmacist presents relevant MRP to the doctor before the patient’s consultation. The pharmacist is also present at the following multidisciplinary conference about the patient. MRP found are recorded in a national database (LRP database).

Results The pharmacist saw 58 patients from May 2012 to September 2013 and highlighted 208 MRP. The patients at the clinic have on average 12.3 (3–26) regular medicines. Twenty-nine patients had potential side effects to their regular medicines (from 1–11).

Ninety-four (45%) of the pharmacist’s 208 suggestions were implemented at the clinic, where 20 were related to the 70 highlighted possible side effects.

Conclusions With special focus on side effects to regular medicines, the pharmacist highlighted potential side effects in 50% of the patients at the clinic for multimorbidity and polypharmacy. Despite the clinic being an outpatient clinic, the acceptance rate for the pharmacist’s suggestions was surprisingly high.

No conflict of interest.

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