Background and importance Potentially inappropriate prescriptions (PIPs) in elderly persons lead to increased morbidity and mortality, greater number of hospital admissions and use of healthcare resources. The periodic clinical review of the prescriptions is necessary to adapt the pharmacotherapy to the current situation of the patient, and the incorporation of the pharmacist in the multidisciplinary team is therefore essential.
Aim and objectives Appropriateness of pharmacotherapy (AP) and analysis of the interventions carried out in elderly patients from nursing homes (NHs) with polypharmacy.
Material and methods Prospective study carried out from October 2020 of a programme of AP in polymedicated patients of NHs, through the implementation of a project for the coordination of Geriatrics, Pharmacy and NHs from a university hospital. The pharmacist carried out a pharmacotherapeutic review of the active prescriptions of the patients, and subsequently prepared an individualised report with proposals for therapeutic optimisation and sent it to the geriatrician for evaluation. PIPs were identified by explicit/implicit criteria (STOPP/START, BEERS, LESS-CHRON, MAI) and CheckTheMeds software, and were classified according to the Third Granada Consensus on Medication-Related-Problems (MRPs). The economic impact was calculated from the direct costs of the discontinued drugs.
Results 102 patients (74.5% women) were revised with feedback from 10 NHs. Median age 88 (IQR 84–93) years. Average of pathologies per patient: 8. Median of prescribed drugs: 13 (IQR 11–15).
495 prescriptions with possible MRPs were detected, the main ones being: unfavourable risk–benefit balance according to the functional situation (29.3%), probability of adverse events (17.6%), inadequate duration of therapy (18.4%), inadequate dose/regimen (16.4%) and duplication (5%). 41% corresponded to PIPs according to STOPP/BEERS or LESS-CHRON criteria. According to the therapeutic group, MRPs have been detected mainly in drugs from group A: 30%, N: 24.2%, C: 18.4% and M: 14%.
81% of the detected MRPs were intervened, with a degree of acceptance of 73%. The main interventions were: suspension or deprescription of drugs (67%) and dose reduction or change of frequency of administration (24%).
23% reduction in the number of drugs prescribed/patient, with an economic saving of €2550/month and €15 700/6 months.
Conclusion and relevance Deprescription strategy in our NHs has been efficient, since a high number of interventions with a high degree of acceptance have been detected. AP supposes great support to clinicians, promoting the rational use of the drugs.
Conflict of interest No conflict of interest
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