Article Text

Impact of joint consultation by a clinical pharmacist and a clinical geriatrician to improve inappropriate prescribing for elderly patients
  1. J J W Ros1,
  2. T J Koekkoek3,
  3. A Kalf2,
  4. P M L A van den Bemt4,
  5. H J M Van Kan1
  1. 1Department of Clinical Pharmacy, Gelre Hospitals, Apeldoorn, The Netherlands
  2. 2Department of Clinical Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
  3. 3Department of Clinical Pharmacy, Rivierenland Hospital, Tiel, The Netherlands
  4. 4Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to J J W Ros, Department of Clinical Pharmacy, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands; jjw.ros{at}


Objective Appropriate prescribing is a key quality element in medication safety. It is unclear if therapeutic interventions resulting from medication review lead to clinically relevant improvements. The effect of medication review on prescribing appropriateness was evaluated in the setting of an outpatient consultation team, consisting of a clinical pharmacist and a clinical geriatrician, in a large non-academic teaching hospital in the Netherlands.

Method A group of 49 elderly patients with polypharmacy was included after referral by their general practitioner for drug related problems. After a regular assessment by a clinical geriatrician and medication record review by a clinical pharmacist, a treatment plan was implemented based on the recommended interventions. The main outcome measure was the change in the Medication Appropriateness Index (MAI) before and 3 months after primary consultation.

Results Overall 82% of the recommended interventions of the pharmacist were implemented by the geriatrician of which 63% persisted up to the last visit. Per patient an average of 6.6 interventions were carried out. The interventions showed a reduction of the MAI per patient of 50%. The number of drugs per patient was reduced from 12.1 to 11.0. The number of medications listed on the Beers list decreased from 2.3 to 1.5 and the number of drugs listed on the Hospital Admissions Related to Medication (HARM) Trigger list decreased from 2.1 to 1.5.

Conclusions Interventions from a multidisciplinary outpatient consultation team were effective in improving appropriate prescribing in elderly outpatients with polypharmacy.

  • clinical geriatrician
  • clinical pharmacist
  • outpatient consultation team
  • elderly patients
  • polypharmacy
  • Medication Appropriateness Index
  • Beers list
  • Harm Trigger list

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