Investigating the impact of a pharmacist intervention on inappropriate prescribing practices at hospital admission and discharge in older patients: a secondary outcome analysis from a randomized controlled trial.

IF 3.4 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Drug Safety Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI:10.1177/20420986241299683

Beate Hennie Garcia, Katharina Kaino Omma, Lars Småbrekke, Jeanette Schultz Johansen, Frode Skjold, Kjell Hermann Halvorsen

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引用次数: 0

Abstract

Background: Inappropriate medication prescribing in older patients increases the risk of poorer health outcomes and increased costs. The IMMENSE trial, integrated a clinical pharmacist into the health care team, to improve medication therapy among older patients, and to investigate the impact on acute revisits to hospital.

Objectives: This study investigated the prevalence of potentially inappropriate medications (PIMs) and prescribing omissions (PPOs) at hospital admission and discharge. It also explored the impact of the pharmacist intervention on PIMs and PPOs, and other factors associated with PIMs and PPOs at discharge.

Design: The STOPP/START criteria version 2 were retrospectively applied at admission and discharge. PIM and PPO changes were compared, and Poisson regression was used to assess factors influencing prevalence at discharge.

Results: At hospital admission, PIM prevalence was 58.6% among intervention patients and 64.8% among control patients. PPO prevalence was 55.3% and 55.5%, respectively. A larger proportion of PIMs identified at admission were resolved by discharge in the intervention group (42.9%) compared to the control group (27.4%). No difference was seen for PPOs. Poisson regression identified a significantly higher risk for PIMs at discharge in the control group compared to the intervention group (IRR 1.255; 95% CI 1.063-1.480, p = 0.007), but no effect for PPOs. Patients living in a nursing home, a home care facility, or an institution showed a higher risk of PPOs at discharge compared to patients living at home (IRR 1.378; 95% CI 1.156-1.644, p < 0.001).

Conclusion: The IMMENSE intervention significantly reduced the risk of PIMs at discharge, with no effect on PPOs. Living in nursing homes, home care facilities, or institutions prior to hospitalization increased the risk of PPOs at discharge. Pharmacists may contribute to improved medication appropriateness in older hospitalized patients.

查看原文本刊更多论文

调查药剂师干预对老年患者入院和出院时不当处方行为的影响：随机对照试验的次要结果分析。

背景：老年患者用药不当会增加健康状况恶化和成本增加的风险。IMMENSE 试验将临床药剂师纳入医疗团队，以改善老年患者的药物治疗，并调查其对急性再住院的影响：本研究调查了入院和出院时潜在用药不当（PIMs）和处方遗漏（PPOs）的发生率。研究还探讨了药剂师干预对潜在用药不当和处方遗漏的影响，以及与出院时潜在用药不当和处方遗漏相关的其他因素：设计：对入院和出院时的 STOPP/START 标准 2 版进行回顾性应用。比较 PIM 和 PPO 的变化，并采用泊松回归法评估影响出院时患病率的因素：入院时，干预组患者的 PIM 患病率为 58.6%，对照组患者为 64.8%。PPO 患病率分别为 55.3% 和 55.5%。与对照组（27.4%）相比，干预组入院时发现的 PIM 在出院时得到解决的比例更高（42.9%）。PPO方面则没有差异。泊松回归发现，与干预组相比，对照组患者出院时出现 PIM 的风险明显更高（IRR 1.255；95% CI 1.063-1.480，p = 0.007），但对 PPO 没有影响。与住在家中的患者相比，住在疗养院、家庭护理设施或机构的患者出院时出现 PPO 的风险更高（IRR 1.378；95% CI 1.156-1.644，p 结论：IMMENSE 干预疗法显著降低了患者出院时出现 PPO 的风险（IRR 1.255；95% CI 1.063-1.480，p = 0.007）：IMMENSE 干预措施大大降低了出院时出现 PIM 的风险，但对 PPO 没有影响。住院前住在疗养院、家庭护理设施或机构会增加出院时出现 PPO 的风险。药剂师可能有助于改善老年住院患者的用药适当性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Drug Safety Medicine-Pharmacology (medical)

CiteScore

6.70

自引率

4.50%

发文量

审稿时长

9 weeks

期刊介绍： Therapeutic Advances in Drug Safety delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies pertaining to the safe use of drugs in patients. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in drug safety, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest on research across all areas of drug safety, including therapeutic drug monitoring, pharmacoepidemiology, adverse drug reactions, drug interactions, pharmacokinetics, pharmacovigilance, medication/prescribing errors, risk management, ethics and regulation.