gms | German Medical Science

23rd Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

24.11. - 25.11.2016, Bochum

Analysis and medication optimization for geriatric inpatients: a prospective intervention study (OptiMe)

Meeting Abstract

  • author presenting/speaker Angela Nachtigall - Clinical Pharmacology, Faculty of Health (Department of Human Medicine), University of Witten/Herdecke, HELIOS Clinical Center, Wuppertal, Germany
  • author Hans J. Heppner - Geriatric Medicine, Faculty of Health (Department of Human Medicine), University of Witten/Herdecke, HELIOS Clinical Center, Schwelm, Germany
  • Silke Lange - Freelance Statistician, Witten, Germany
  • corresponding author Petra A. Thürmann - Clinical Pharmacology, Faculty of Health (Department of Human Medicine), University of Witten/Herdecke, HELIOS Clinical Center, Wuppertal, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 23. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bochum, 24.-25.11.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16gaa04

doi: 10.3205/16gaa04, urn:nbn:de:0183-16gaa046

Published: November 23, 2016

© 2016 Nachtigall et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: Demographic changes associated with increasing age and multimorbidity pose challenges to health care professionals. Guideline-adapted treatment of multimorbid geriatric patients often leads to polypharmacy [1]. Drug related problems (DRP) and drug-drug interactions (DDI) are the consequences, which are often unpredictable. Teamwork between pharmacists, physicians and other professions as well as an optimized medication management becomes increasingly important to improve safety of drug therapy.

Materials and Methods: The aim of this prospective controlled intervention study was to compare the medication quality between a) the status at hospitalization and b) discharge and to assess the impact of a standardized pharmacist’s medication review.

Inclusion criteria for patients were the prescription of at least five drugs (considered as polypharmacy), age of 70 years or above and written informed consent. Patients on ward A were assigned to the intervention group while ward B was the control ward. Allocation to ward A or B was done study-independently by the administration department of the clinic, resulting in a quasi-randomization. The study protocol was approved by the ethics committee of the University of Witten/Herdecke.

Screening and analysis of prescribed drugs were performed using the Medication Appropriateness Index (MAI) [2] and the PRISCUS-list [3]. For the intervention group, the pharmacist formulated a recommendation also taking into account functional scores (mobility and cognition) and the preference of the patient as identified by a questionnaire. Subsequently the recommendation was discussed with the ward physician.

The endpoint of the study was the detection of a drug-related problem (DRP) which was defined as one of the following: 1. Adverse Drug Reaction (ADR), 2. Drug-Drug-Interaction classified by ABDA-database as “simultaneous use not recommended“ or worse, 3. prescription of a PRISCUS-PIM (potentially inappropriate medication), 4. Drug given without indication. Statistical analyses were performed using SAS® 9.3 and IBM® SPSS® Statistics 23.

Results: 411 patients were recruited in the Geriatric hospital in Schwelm (North Rhine – Westphalia, Germany) from January to December 2015, 209 in the intervention and 202 in the control group. 64% were female and 36% male, the average age was 81.9 (70-103) years. The median hospitalization time was 19 days.

On admission 86.6% (n=181) of patients in the intervention group and 76.7% (n=155) of patients in the control group exhibited a DRP.

At the time of discharge the rate of DRPs was reduced to 56% (n=117) in the intervention group while the DRP-rate in the control group remained unchanged (76.2%; n=154) (Fisher's exact test comparing DRP rates at discharge of the two groups: p < 0.001).

Conclusion: Our study showed a high rate of geriatric patients with DRP. The intervention of a medication review performed by a ward pharmacist significantly reduced the number of DRP and thus contributed to patient safety. This study adds to the already existing evidence supporting the impact of pharmaceutical care on optimization of pharmacotherapy, especially with regard to an aging population and the resulting polypharmacy [4].

This study was supported by Paul-Kuth-Stiftung; HELIOS Kliniken GmbH, grant ID: 063614; Robert Bosch Stiftung grant ID: 32.5.1141.0059.0


References

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Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005; 294(6):716-24.
2.
Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045-51.
3.
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31-32):543-51. DOI: 10.3238/arztebl.2010.0543. Epub 2010 Aug 9. External link
4.
Cooper JA, Cadogan CA, Patterson SM, Kerse N, Bradley MC, Ryan C, Hughes CM. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. 2015;5(12):e009235. DOI: 10.1136/bmjopen-2015-009235 External link