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4CPS-232 Pharmacist-led medication review unveiled more medication-related problems in possibly medication-related hospitalisations than in unlikely medication-related hospitalisations in elderly patients
  1. D Protzenko1,
  2. J Nakache1,
  3. M Lombardi1,
  4. L Cesari1,
  5. S Honoré1,2,3,
  6. S de la Brosse4,
  7. G Hache1,2
  1. 1AP-HM CHU Timone, Service de Pharmacie, Marseille, France
  2. 2Aix-Marseille University, Faculté de Pharmacie, Marseille, France
  3. 3L’Omédit, PACA-Corse, Marseille, France
  4. 4AP-HM CHU Timone, Service de Médecine d’Urgence, Marseille, France


Background and importance Elderly patients are prone to unsafe and/or ineffective pharmacotherapy. Medication-related admissions are common in older people and over half of these hospitalisations are preventable.

Aim and objectives The aim of this study was to identify medication-related problems associated with medication-related admissions in hospital in older people.

Material and methods We performed a retrospective study by analysing the folders of patients over 75 years old, undergoing pharmacist-led medication review as part of the multidisciplinary geriatric mobile team, between March and October 2021. We performed the assessment tool for identifying hospital admissions related to medicine (AT-HARM10) to assess hospital admissions as being either possibly or unlikely medication-related (MRH). First, we compared demographic- and therapeutic-related variables between possibly and unlikely MRH. Therapeutic-related variables were number of treatments upon admission, potentially inappropriate medication as measured by both START/STOPP and PIMcheck, number of drug interactions, drug burden index (DBI), and number of medication errors during medication reconciliation at admission. Secondly, we performed univariate logistic regression by calculating odds ratios with 95% confidence intervals to identify mediation-related problems associated with MRH.

Results We included 67 patients, 32 possibly MRH and 35 unlikely MRH. Most demographics were comparable between the two groups except a higher proportion of women (81.3% vs 54.3%; p<0.05) and less under nutrition (16.7% vs 54.5%; p<0.05) in possibly MRH. In possibly MRH, we found higher numbers of (i) START/STOPP items (4.8±2.7 vs 2.3±2.0; p<0.05), (ii) PIMcheck overuses (2.0±1.7 vs 1.3±1.4; p<0.05), (iii) drug interactions (8.7±8.9 vs 4.6±4.9; p<0.05) and a higher DBI score (0.9±0.8 vs 0.3±0.5; p<0.05). Interestingly, we unveiled more medication errors during medication reconciliation at admission in possibly MRH (4.3±3.3 vs 2.7±2.3; p<0.05).

START/STOPP items (OR 1.54; 95% CI 1.21 to 1.96), PIMcheck overuses (OR 1.5; 95% CI 1.05 to 2.13), drug interactions (OR 1.13; 95% CI 1.02 to 1.24) were identified as medication-related problems associated with MRH. DBI (OR 5.8; 95% CI 2.05 to 16.42) was also significantly associated with MRH.

Conclusion and relevance Our results illustrate a balanced proportion of MRA in patients treated by the multidisciplinary geriatric mobile team. We unveiled more medication-related problems in patients possibly MRH than in unlikely MRH, suggesting that AT-HARM10 may be used to identify patients requiring priority on pharmacist-led medication review.

Conflict of interest No conflict of interest

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