Background Patients can have several illnesses concurrently and regular medicines reviews have been recommended for those over 75. Pharmacists are a potential source of assistance in reviewing medicines.

Purpose To assess a pharmaceutical care programme based on monitoring of drug treatments in chronically hospitalised patients; to resolve drug-related problems (DRP) and thus reduce their associated cost.

Results 171 chronically-ill patients were selected with DRP. (4‰ of patients hospitalised). Conditions diagnosed per patient: 5.5(SD:2), common medicines: 8.4(SD:3.5) emergency visits: 9.8(SD:11.9) and hospital admissions: 4.1(SD:3.3) in the last 10 years. We recorded 194 DRP (1.1 problem/patient), identified by validation (67%) and analytical parameters (24%). 70% of DRP were detected and resolved before the patient received the drug, while 30% of DRP were resolved after the patient had received the drug. The main problems were the dosage (47%), wrong drug (34%) and duplication (10%). The DRP could alternatively be related to safety (51%), indication (31%) and effectiveness (18%).

The recommendations made included individualising drug dosage (46%), stopping the drug (19%) and suggesting an alternative treatment (14%). The therapeutic groups involved were: anti-ulcers (14%), antihypertensives (12%) and antibiotics (10%). 91% of the actions were accepted by physicians. 62% were relevant to improving patient care and 30% were clinically significant. The economic impact was 114,649 €/year saved.

Conclusions Chronic care management requires the involvement of all health professionals. A pharmaceutical care programme based on pharmacotherapeutic monitoring resolved DRPs in chronically-ill patients older than 80 years and improved the quality of treatment, at the same time saving money.

No conflict of interest.