Pharmacist Medication Optimisation Service Enhances Medication Appropriateness in Hospitalized Elderly Patients with Polypharmacy: A Prospective, Randomised Controlled Study

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Authors (including presenting author) :
Wong KS(1), Sit WY(1), Lau WM(1), Mak SY(1), Lee WY(2), Yeung TF(3)
Affiliation :
(1) Pharmacy Department, Our Lady of Maryknoll Hospital (2) School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, (3)Department of Medicine & Geriatrics, Our Lady of Maryknoll Hospital
Introduction :
Inappropriate prescribing is prevalent in elderly patients with polypharmacy. Increased hospitalization and adverse drug reactions due to inappropriate prescribing can add burden on public health care system.
Objectives :
To evaluate the impact of ward-based medication optimization service provided by pharmacists on the medication appropriateness in hospitalized elderly patients with polypharmacy in Our Lady of Maryknoll Hospital (OLMH).
Methodology :
This is a prospective, randomised controlled study. Elderly ≥65 with polypharmacy (i.e. ≥5 chronic drugs) admitted to a medical ward in OLMH were randomised to receive either pharmacist medication optimization service on ward, or existing pharmaceutical care. The service included (i) admission medication reconciliation; and (ii) patient chart and medication review on alternate day basis. Any unintentional discrepancies or drug-related problems identified were brought to the attention of physicians with recommendations. Drug-related problem identified was categorized using a validated tool called Medication Appropriateness Index (MAI), consisting of 10 criteria with different weighting. Higher MAI score indicates more inappropriateness of a medication and is related to increased hospitalization or emergency room visits. The number of suggestions made to physicians and the acceptance rate were documented.
Result & Outcome :
Total 162 eligible patients were recruited from Dec 2016 to Apr 2018. There was no statistically significant difference in the average summated MAI scores at admission between the intervention and the control group (P=0.56). The average summated MAI scores at admission and on discharge decreased significantly (2.34 to 1.22, P< 0.001) in the intervention group (n=80) but not in the control group (n=82, 2.39 to 2.02; P=0.097). The difference of the average summated MAI scores on discharge between two groups was statistically significant (P=0.046). Total 2,860 medication orders were assessed using MAI. Two hundred and eighty-nine (10.1%) medication orders were rated inappropriate in at least one of the criteria in MAI. Total 44 suggestions were made to physicians and the overall acceptance rate was 54.1%. Pharmacists’ involvement through ward-based medication optimization service was able to assist physicians in identifying inappropriate medication use and enhance appropriateness of prescribing for elderly patients with polypharmacy from admission to discharge.

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