108 Medication review in elderly

Abstract

Objectives The number of elderly is increasing in our society. This population group suffers from more chronic diseases and is therefore taking more medications. Polypharmacy and inappropriate use of medication increase the risk of adverse drug reactions and is a contributor to unplanned hospitalization. Therefore, it is important to focus on inappropriate use of medication and to promote rational pharmacotherapy and thereby prevent hospitalization among the elderly. The objective of this pilot study was to develop a medication review model with special focus on the medication taken by elderly living in nursing homes and to investigate and measure the degree of implementation of potential medication changes. The main focus of the medication reviews was on four medications; antibiotic, pain patches, antipsychotics and anti-dementia drugs. Method This study was an intervention study in which medication reviews were performed in corporation between a pharmacist and a consulting physician from the Department of Clinical Pharmacology at Copenhagen University Hospital Bispebjerg in the Capital Region of Denmark and the patients´ general practitioner. Only participants living in nursing homes in the Capital Region of Denmark and in treatment with antibiotic, pain patches, antipsychotics or anti-dementia drugs were included. The intervention consisted of two parts. First the pharmacist and the consulting physician performed a medication review with access to information about the patient´s medication, diagnosis, laboratory result and health information. This was followed by a meeting between the pharmacist, the consulting physician and the patient’s general practitioner in order to discuss the potential changes in the patient´s medication. Finally, a four month follow-up to evaluate the degree of implementation of the accepted medication changes was performed. Results 100 patients were included and 49 informed consents were collected. 30 (61.2%) were females and the average age of the participants was 85.3 years (SD ±9.5). Medication reviews were performed and in total 530 prescriptions were reviewed. In average, the participants were treated with 10.8 medications. 109 interventions were suggested and qualified by the patient´s general practitioner. 99% of the proposed changes were approved by the general practitioner and the most frequent type of intervention was discontinuation (43.5%) followed by dose reduction (23.5%) and reassessment of the treatment (22.6%). Among the 109 interventions only 18.3% were concerning the four medications in focus (antibiotic 4.3%, pain patches 1.7%, antipsychotics 11.3% and anti-dementia drugs 0.9%). After four months 34.3% interventions had been implemented and 2.8% had been partly implemented. Conclusions The type of medication review performed here showed a high degree of approved proposals which can be due to the structure of the medication review. The preliminary result showed that the medications in focus were not among the most frequent interventions indicating that the reassessment of high risk medication is complex and that irrational pharmacotherapy concerns a wide variety of medications. Therefore the four medications in focus were not suited as inclusion criteria for this type of study identifying patients in high risk of adverse drug reaction.