Pharmaceutical care by a specialist clinical pharmacist significantly improved the Medication Appropriateness Index (OR 9.1; 95% CI 4.2-21.6) and ACOVE underuse criteria from admission to discharge.
RCT (n=203)
Patient as unit of randomization
Does pharmaceutical care provided by a specialist clinical pharmacist improve the appropriateness of prescribing in geriatric inpatients aged 70 and older?
The addition of a specialist clinical pharmacist to an acute geriatric evaluation and management team significantly improves the appropriateness of medication prescribing for elderly inpatients.
Odds Ratio: 9.1 (95% CI 4.2–21.6)
OBJECTIVES: To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management (GEM) care on the appropriateness of prescribing. DESIGN: Randomized, controlled trial, with the patient as unit of randomization. SETTING: Acute GEM unit. PARTICIPANTS: Two hundred three patients aged 70 and older. INTERVENTION: Pharmaceutical care provided from admission to discharge by a specialist clinical pharmacist who had direct contacts with the GEM team and patients. MEASUREMENTS: Appropriateness of prescribing on admission, at discharge, and 3 months after discharge, using the Medication Appropriateness Index (MAI), Beers criteria, and Assessing Care of Vulnerable Elders (ACOVE) underuse criteria and mortality, readmission, and emergency visits up to 12 months after discharge. RESULTS: Intervention patients were significantly more likely than control patients to have an improvement in the MAI and in the ACOVE underuse criteria from admission to discharge (odds ratio (OR)=9.1, 95% confidence interval (CI)=4.2-21.6 and OR=6.1, 95% CI=2.2-17.0, respectively). The control and intervention groups had comparable improvements in the Beers criteria. CONCLUSION: Pharmaceutical care provided in the context of acute GEM care improved the appropriate use of medicines during the hospital stay and after discharge. This is an important finding, because only limited data exist on the effect of various strategies to improve medication use in elderly inpatients. The present approach has the potential to minimize risk and improve patient outcomes.
Spinewine et al. (Tue,) conducted a rct in Geriatric inpatients (n=203). Pharmaceutical care by a specialist clinical pharmacist vs. Control was evaluated on Improvement in the Medication Appropriateness Index (MAI) from admission to discharge (OR 9.1, 95% CI 4.2-21.6). Pharmaceutical care by a specialist clinical pharmacist significantly improved the Medication Appropriateness Index (OR 9.1; 95% CI 4.2-21.6) and ACOVE underuse criteria from admission to discharge.
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