Background and Importance Increased life expectancy has supposed a higher presence of comorbidities leading to polypharmacy rising the prevalence of potentially inappropriate prescriptions (PIPs) and high-risk medication (HRM) burden. PIPs can be a cause of harm or no longer provide health benefits which is why pharmacists-led interventions aimed at detecting and reducing it have emerged during recent years.

Aim and Objectives Assess the prevalence of PIPs, HRM and contraindicated medications in chronic complex patients (CCP) to whom pharmacist-led in-hospital reconciliation have been performed and to determine de HRM burden consequence of PIPs.

Material and Methods Cross-sectional study on hospitalised CCP between March and April 2022. Pharmacist-led medication reconciliation, PIPs identification (using the List of Evidence-based deprescribing for chronic patients (LESS-CHRON) criteria) and contraindicated (using the Spanish datasheet) and HRM (using the High-Alert Medications in chronic patients Institute for Safe Medication Practices (ISMP) list) identification was performed.

Demographic data together with Pfeiffer and Barthel index were collected from patients’ medical records. Chi-square test was utilised to determine differences in the proportion of PIPs between HRM and non-HRM.

Results 60 patients were included, (43.3% women, mean age was 76.8 ± 9.8 years). Pfeiffer index was 0-2 (normal cognitive level) in 35(58.3%) and Barthel index was 60-99 (low dependence level in 26(43.4%) of patients. Mean number of prescribed medications was 12.8 ± 4.7. At least one PIP was detected in 100% of patients (mean number of 4.7 ± 4.1 PIPs). In 11 patients (18.3%) the detected HMR also was PIPs. Mostly involved drugs were benzodiazepines (72.7% of cases), spironolactone (9.1%), vildagliptine (9.1%) and quetiapine (9.1%). In 13 cases (21.7%) HRM was also contraindicated (23% oral anticoagulants, 23% digoxine and 15% eplerenone). There were non-significant differences in the proportion of PIPs between HRM and non-HRM (3.9% vs 3%, p≥0.05).

Conclusion and Relevance Considering these findings, a high prevalence of PIPs was found through pharmacist-led assessment in hospitalised CCP according to LESS-CHRON criteria.

Moreover from HRM assessed by IRMP, a high number of PIPS and contraindicated medication were identified, of which benzodiazepines and anticoagulants were the most detected according to the literature and the results obtained.

This fact highlights the need for pharmacists-led treatment-assessment and optimisation programs in this population.

Conflict of Interest No conflict of interest