Background Drug-related problems (DRPs) are common among elderly patients using several drugs for the treatment of chronic diseases. The aim of the study was to evaluate the role of the hospital pharmacist in detecting and acting on problems related to home treatment.
Purpose To describe and analyse a program that enables a pharmacist to review home treatment at admission to a Short Stay Unit (SSU).
Material and methods The study was conducted from January 2014 to May 2014 in a general hospital. Polymedicated patients over 65 years old and awaiting SSU admission were included. The pharmacist developed the home medicines list using electronic primary care records, interview with the patient/caregiver and review of the medication bag. When DRPs were identified, they were reported to the physician through a document that contained treatment information and appropriate pharmacotherapy recommendations (PR). The physician had the information before the first prescription. The incidence and types of DRPs and acceptance of the PR conducted was measured.
Results 46 patients were selected, registering 529 chronic medicines in total, with an average of 11.5 ± 4.2 per patient. The mean age was 76 ± 9.6. The most frequent reasons for admission were heart failure (19.6%), acute exacerbation of COPD (15.2%), respiratory infection (10.9%) and acute bronchitis (10.9%). The average stay was 3.5 ± 2.7 days. In total 86 PRs were performed on 71.7% of patients (mean 1.9 ± 1.8). 50% of PRs were accepted. The PR distribution was: dose adjustment or posology 35 (62.9% accepted), drug interaction 24 (45.8% accepted), therapeutic equivalent 16 (37.5% accepted), contraindication or dose adjustment for IRC 7 (100% accepted), 1 duplication (1 accepted), 3 others (1 accepted). Therapeutic groups most frequently involved in the recommendations were antihypertensives 17.4%, inhaled β-agonists 16.3%, oral antidiabetics 9.3% and diuretics 8.1%.
Conclusion The high incidence of DRPs in patients considered at risk in our study highlights the importance of this type of intervention, admission to SSU resulting in an opportunity to optimise home treatment. The high degree of medical acceptance of pharmaceutical interventions shows its usefulness.
References and/or acknowledgements No conflict of interest.
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