Background and importance The National Health Authority calls for initiatives ensuring that relevant elderly polypharmacy patients receive medication reviews during hospital admission to reduce the risk of adverse events. Potentially inappropriate medications (PIMs) are one of the most frequent causes of adverse events in older people. Pharmacist led systematic medication reviews are time consuming, and while hospital length of stay has progressively reduced to an average of a few days, the effort has to be aimed at PIM interventions that are best suited to being carried out by a hospital physician.
Aim and objectives The purpose of the study was to develop a screening model to identify patients who may benefit from a pharmacist led medication review in hospital.
Material and methods A screening model was developed using PIMs described in the international literature and the workflow of pharmaconomists and clinical pharmacists in local hospitals. The screening model was applied to all elderly polypharmacy patients admitted to bed wards having pharmaconomist medicine management in five hospitals. Patients fitting the model were identified by pharmaconomists and referred to a pharmacist led medication review. The pharmacist led medication review was performed centrally with the aim of reducing the number of drugs, number of PIMs and complexity of the medication regimen. The primary outcome was the number of PIMs at discharge compared with the number of PIMs at admission to hospital.
Results The screening tool in the model comprised 10 medication focus points and demonstrated a specificity of 78% and sensitivity of 80% in detecting the relevant patients when applied to a cohort of elderly polypharmacy patients. From April to June 2018, 17 631 patients were screened using the tool. The pharmaconomists referred 396 patients to the pharmacists (average age 78 years, 52% women). Of these, 229 received a pharmacist led medication review (average of 2.78 interventions/patient). For the 115 patients with a possible follow-up, the average number of PIMs/patient was significantly reduced (p<0.001) from 2.02 PIMs at admission to 1.57 PIMs at the end of hospital admission.
Conclusion and relevance The screening model developed detected relevant elderly polypharmacy patients for a pharmacist led medication review during hospital admission. The model was easily implemented, low resource and resulted in a significantly reduced number of potentially inappropriate medications.
Conflict of interest No conflict of interest
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