The role of the pharmacist in optimizing pharmacotherapy in older people.
ABSTRACT Prescription of medicines is a fundamental component of the care of older people, but evidence suggests that pharmacotherapy in this population is often inappropriate. Pharmacists have been involved in different approaches for the optimization of prescribing and rational medication use in older people. This article describes the different models of care in which pharmacists are involved in the optimization of pharmacotherapy in older people, and reviews the impact of these approaches on both process and outcome measures. The provision of pharmaceutical care, medication reviews and educational interventions by pharmacists in the nursing home, ambulatory and acute care settings are discussed. We selected systematic reviews, reviews and original studies, and for the latter, we focused more specifically on European publications published between 2001 and 2011. From the literature reviewed, it is clear that when pharmacists play a proactive role in performing medication reviews and in the active education of other healthcare professionals, pharmacotherapy for older patients is improved. However, the evidence of the impact of pharmacists' interventions on health outcomes, quality of life or cost effectiveness of care is mixed. Better results have been reported when pharmacists are skilled and work in the context of a multidisciplinary team. Opportunities remain for multicentre, European-based, pharmacist-intervention trials in all settings, to determine the effectiveness and economic benefit of pharmacist involvement in the optimization of pharmacotherapy in older people.
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ABSTRACT: The objective of this literature review was to evaluate the evidence pertaining to the impact of medication reviews and/or educational interventions on psychotropic drug use in long-term care facilities. A computerized search was conducted using MEDLINE, Cochrane Central Register of Control Trials, CINAHL, EMBASE, International Pharmaceutical Abstracts and PsycINFO, from January 1980 to April 2007. Controlled studies or randomized controlled studies were included for review. The authors identified 26 studies evaluating the impact of medication reviews and/or educational interventions on psychotropic drug use in long-term care facilities. Eleven studies met the inclusion criteria for this review and the data from six of these studies were included in a meta-analysis. The pooled odds ratio (OR) from five studies on hypnotic prescribing showed a decrease in use postintervention (OR = 0.57, 95% confidence intervals [CI] = 0.41-0.79). The pooled OR from five studies on prevalence of antipsychotic prescribing postintervention was not significant (OR = 0.81, 95% CI = 0.63-1.04). Medication reviews and/or educational interventions are effective at reducing psychotropic drug prescribing. However, research on the benefits of these interventions in reducing psychotropic drug use on total health care costs and resident health outcomes is lacking.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 09/2008; 16(8):621-32. · 3.35 Impact Factor
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ABSTRACT: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI). Cluster randomized controlled trial. Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11). Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control). Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care. The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI. The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14-0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups. Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.Journal of the American Geriatrics Society 12/2009; 58(1):44-53. · 3.98 Impact Factor
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ABSTRACT: To assess whether home-based medication review by a pharmacist for at-risk older patients in a primary care setting can reduce hospital admissions. Randomised controlled trial comparing home-based medication review with standard care. Home-based medication review of 136 patients registered with one general practice. Study participants were over 80 years of age, living at home, taking four or more medicines, and had at least one additional medicines-related risk factor. The intervention comprised two home visits by a community pharmacist who educated the patient/carer about their medicines, noted any pharmaceutical care issues, assessed need for an adherence aid, and subsequently met with the lead GP to agree on actions. Total non-elective hospital admissions within 6 months. Secondary outcomes included number of deaths, care home admissions and quality of life (EQ-5d). Impact on number of medicines prescribed was also assessed. At 6 months, no difference in hospital admissions (21 intervention versus 20 control P = 0.80), and no difference in care home admissions or deaths were detected between groups. There was a small (non-significant) decrease in quality of life in the intervention group. There was a statistically significant reduction in the mean number of medicines prescribed ( -0.87 items in favour of the intervention group, 95% confidence interval -1.66 to -0.08, P = 0.03). No positive impact on clinical outcomes or quality of life was demonstrated, however, this intervention did appear to reduce prescribing. This is in line with other evidence and suggests that this form of intervention may not have a clear health gain, but may lead to modest savings in terms of reduced prescribing. Future research should focus on whether such a prescribing effect would make this type of intervention cost effective.Age and Ageing 06/2007; 36(3):292-7. · 3.82 Impact Factor