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4CPS-114 Integration of a pharmacist into a geriatric department
  1. D Tejada Marín,
  2. A Rodriguez Esquiroz,
  3. D Fresán Restituto,
  4. R San Miguel Elcano,
  5. A Cedeño Veloz,
  6. V Roncal Belzunce,
  7. N Martinez Velilla,
  8. M Sarobe Carricas
  1. Complejo Hospitalario de Navarra, Pharmacy, Pamplona, Spain


Background and importance Elderly chronic patients are usually pluripathological and polymedicated, which makes them vulnerable and complex to deal with. The review of their pharmacological treatment and their interactions, deprescribing and managing medications provides safety and improves their quality of life in a context of pharmacotherapy optimisation.

Aim and objectives To create a healthcare resource between the services of geriatrics and hospital pharmacy which facilitates clinical management of arranged patients for a medical consultation in outpatient geriatric clinic.

Material and methods Prospective study which included patients arranged for a geriatric consultation for the first time between May 2021 and August 2021. All these items were considered: pharmacotherapy, adherence to medical treatment, medical history, final analysis and last hospital admission. Treatment optimisation recommendations were mentioned to the geriatric physician. Primary care, specialised and emergency consultations were recorded the month following the aforementioned changes.

Results 33 patients were included, of whom 64% were women, mean age 86 (SD 4.4) years. 113 interventions were carried out (3.4 per patient), most of which were due to therapeutic optimisation (23%), excessive treatment duration (21%) and medical interactions (13%). Also, no specific therapeutic indications (11%) and incorrect dosage (4%) were noted. A dose adjustment was proposed in 40% of the interventions and the modification of therapeutic agents in 14%. Changes were accepted in 65% of the proposals. 26 pharmacotherapeutic groups were involved in the interventions, with antihypertensives, lipid-lowering drugs and benzodiazepines being the most affected ones. The month following the intervention, only 3 patients needed to go to the doctor due to the changes made: high blood pressure (n=1) and insomnia (n=2) were the problems reported. None of the patients required emergency assistance.

Conclusion and relevance The introduction of the figure of the hospital pharmacist into a multidisciplinary approach for elderly, fragile patients enables an optimisation of their pharmacotherapy in order to achieve an effective detection of medical problems, all of which results in an improvement of their quality of life.

Conflict of interest No conflict of interest

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