Evaluating Pharmacist Interventions and Commonly Used Medications in the Geriatric Ward of a Teaching Hospital: A Retrospective Analysis
Main Article Content
Keywords
pharmaceutical care, clinical pharmacy, elderly, medication review, polypharmacy, potentially inappropriate medication
Abstract
The prevalence of diseases increases with aging, leading to complex medication regimens among the elderly population. This study aimed to classify drug-related problems (DRPs), pharmacist interventions, and frequently prescribed medications concerning potential DRPs in patients admitted to the geriatric ward of a teaching hospital in Turkey.
Methods: Retrospective analysis of pharmacist medication review reports for 200 orders of 91 patients (mean age: 80.33±0.46) was conducted.
Results: A total of 1,632 medications were assessed, with 329 interventions proposed for possible DRPs in 156 orders. Polypharmacy (≥5 drugs, mean: 8.17±0.23) correlated with higher DRP occurrence (1.66±0.11 vs. 1.04±0.15, P<0.05). Adverse drug events were identified in 71.31% of cases, primarily due to drug interactions (40.12%). Only 22 potentially inappropriate medications were prescribed. Common interventions included therapy monitoring (31.0%), discontinuation (20.06%), and dosage adjustment (13.98%), with an 85.41% acceptance rate by geriatricians. Most frequently prescribed drugs targeted the nervous system, alimentary tract, metabolism, and cardiovascular system. Pharmacists identified 23 drugs with inappropriate pharmaceutical forms.
Conclusion: The study underscores the underutilization of clinical pharmacy services in Turkey's geriatric care. Collaboration between geriatricians and pharmacists is crucial, as evidenced by high acceptance rates of pharmacist interventions addressing various DRPs and medication classes in interdisciplinary geriatric teams.
References
1. United Nations World Population Prospects. The 2017 revision. Key findings and advance tables. 2017. Available from: https://esa.un.org/unpd/wpp/publications/files/wpp2017_keyfindings.pdf. Accessed January 5, 2019.
2. Cortejoso L, Dietz RA, Hofmann G, Gosch M, Sattler A. Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany. Clin Interv Aging. 2016;11:1343–1350. doi:10.2147/CIA.S109048
3. Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32(2):113–121. doi:10.1111/j.1365-2710.2007.00793.x
4. Mangin D, Bahat G, Golomb BA, et al. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): position statement and 10 recommendations for action. Drugs Aging. 2018;35(7):575–587. doi:10.1007/s40266-018-0554-2
5. Shim YW, Chua SS, Wong HC, Alwi S. Collaborative intervention between pharmacists and physicians on elderly patients: a randomized controlled trial. Ther Clin Risk Manag. 2018;14:1115–1125. doi:10.2147/TCRM.S146218
6. Brahma DK, Wahlang JB, Marak MD, Ch Sangma M. Adverse drug reactions in the elderly. J Pharmacol Pharmacother. 2013;4(2):91–94. doi:10.4103/0976-500X.110872
7. Suggett E, Marriott J. Risk factors associated with the requirement for pharmaceutical intervention in the hospital setting: a systematic review of the literature. Drugs Real World Outcomes. 2016;3(3): 241–263. doi:10.1007/s40801-016-0083-4
8. Pharmaceutical Care Network Europe Foundation. The PCNE classification V 8.02, 2018. Available from: https://www.ismp.org/sites/default/files/attachments/2018-10/highAlert2018new-Oct2018-v1.pdf. Accessed January 5, 2019.
9. Gammie T, Vogler S, Babar ZU. Economic evaluation of hospital and community pharmacy services. Ann Pharmacother. 2017;51(1):54–65. doi:10.1177/1060028016667741
10. Westerlund T, Marklund B. Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J Clin Pharm Ther. 2009;34(3):319–327. doi:10.1111/j.1365-2710.2008.01017.x
11. Abunahlah N, Elawaisi A, Velibeyoglu FM, Sancar M. Drug related problems identified by clinical pharmacist at the Internal Medicine Ward in Turkey. Int J Clin Pharm. 2018;40(2):360–367. doi:10.1007/s11096-017-0585-5
12. Apikoglu-Rabus S, Yesilyaprak G, Izzettin FV. Drug-related problems and pharmacist interventions in a cohort of patients with asthma and chronic obstructive pulmonary disease. Respir Med. 2016;120:109–115. doi:10.1016/j.rmed.2016.10.006
13. Bosnak AS, Birand N, Diker O, Abdi A, Basgut B. The role of the pharmacist in the multidisciplinary approach to the prevention and resolution of drug-related problems in cancer chemotherapy. J Oncol Pharm Pract. 2018. doi:10.1177/1078155218786048
14. Demirkan K, Bayraktar-Ekincioglu A, Gulhan-Halil M, Abbasoglu O. Assessment of drug administration via feeding tube and the knowledge of health-care professionals in a university hospital. Eur J Clin Nutr. 2017;71(2):164–168. doi:10.1038/ejcn.2016.147
15. Halvorsen KH, Ruths S, Granas AG, Viktil KK. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scand J Prim Health Care. 2010;28(2):82–88. doi:10.3109/02813431003765455
16. Korcegez EI, Sancar M, Demirkan K. Effect of a pharmacist-led program on improving outcomes in patients with type 2 diabetes mellitus from northern cyprus: a randomized controlled trial. J Manag Care Spec Pharm. 2017;23(5):573–582. doi:10.18553/jmcp.2017.23.5.573
17. Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium–description of the impact on a geriatric unit. Ann Pharmacother. 2006;40(4):720–728. doi:10.1345/aph.1G515
18. Wilson S, Wahler R, Brown J, Doloresco F, Monte SV. Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Care. 2011;28(5):316–320. doi:10.1177/1049909110391080
19. Selcuk A, Sancar M, Okuyan B, Demirtunc R, Izzettin FV. The potential role of clinical pharmacists in elderly patients during hospital admission. Pharmazie. 2015;70(8):559–562.
20. Somers A, Robays H, De Paepe P, Van Maele G, Perehudoff K, Petrovic M. Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital. Clin Interv Aging. 2013;8:703–709. doi:10.2147/CIA.S42162
21. Van der Linden L, Hias J, Dreessen L, et al. Medication review versus usual care to improve drug therapies in older inpatients not admitted to geriatric wards: a quasi-experimental study (RASP-IGCT). BMC Geriatr. 2018;18(1):155. doi:10.1186/s12877-018-0843-y
22. LA U, Arun M, Ege M, et al. Media Pharma İnteraktif İlaç Bilgi Kaynağı 2018. In: Ustunes L, editor GEMAŞ Genel Mühendislik Mekanik Sanayi ve Ticaret A.Ş. İzmir, Turkey; 2018.
23. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–2246. doi:10.1111/jgs.13702
24. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–218. doi:10.1093/ageing/afu145
25. Allemann SS, van Mil JW, Botermann L, Berger K, Griese N, Hersberger KE. Pharmaceutical care: the PCNE definition 2013. Int J Clin Pharm. 2014;36(3):544–555. doi:10.1007/s11096-014-9933-x
26. van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38(5):859–867. doi:10.1345/aph.1D182
27. Baijens LW, Clave P, Cras P, et al. European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–1428. doi:10.2147/CIA.S107750
28. Bo M, Gibello M, Brunetti E, et al. Prevalence and predictors of inappropriate prescribing according to the screening tool of older people’s prescriptions and screening tool to alert to right treatment version 2 criteria in older patients discharged from geriatric and internal medicine wards: a prospective observational multicenter study. Geriatr Gerontol Int. 2019;19(1):5–11.
29. Piau A, Huet Y, Gallini A, Andre L, Vellas B, Nourhashemi F. Optimization of drug therapy in elderly individuals admitted to a geriatric unit. Clin Interv Aging. 2017;12:1691–1696. doi:10.2147/CIA.S132309
30. Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med. 1991;114(11):956–966.
31. Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079–2086. doi:10.2147/CIA.S71178
2. Cortejoso L, Dietz RA, Hofmann G, Gosch M, Sattler A. Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany. Clin Interv Aging. 2016;11:1343–1350. doi:10.2147/CIA.S109048
3. Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32(2):113–121. doi:10.1111/j.1365-2710.2007.00793.x
4. Mangin D, Bahat G, Golomb BA, et al. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): position statement and 10 recommendations for action. Drugs Aging. 2018;35(7):575–587. doi:10.1007/s40266-018-0554-2
5. Shim YW, Chua SS, Wong HC, Alwi S. Collaborative intervention between pharmacists and physicians on elderly patients: a randomized controlled trial. Ther Clin Risk Manag. 2018;14:1115–1125. doi:10.2147/TCRM.S146218
6. Brahma DK, Wahlang JB, Marak MD, Ch Sangma M. Adverse drug reactions in the elderly. J Pharmacol Pharmacother. 2013;4(2):91–94. doi:10.4103/0976-500X.110872
7. Suggett E, Marriott J. Risk factors associated with the requirement for pharmaceutical intervention in the hospital setting: a systematic review of the literature. Drugs Real World Outcomes. 2016;3(3): 241–263. doi:10.1007/s40801-016-0083-4
8. Pharmaceutical Care Network Europe Foundation. The PCNE classification V 8.02, 2018. Available from: https://www.ismp.org/sites/default/files/attachments/2018-10/highAlert2018new-Oct2018-v1.pdf. Accessed January 5, 2019.
9. Gammie T, Vogler S, Babar ZU. Economic evaluation of hospital and community pharmacy services. Ann Pharmacother. 2017;51(1):54–65. doi:10.1177/1060028016667741
10. Westerlund T, Marklund B. Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J Clin Pharm Ther. 2009;34(3):319–327. doi:10.1111/j.1365-2710.2008.01017.x
11. Abunahlah N, Elawaisi A, Velibeyoglu FM, Sancar M. Drug related problems identified by clinical pharmacist at the Internal Medicine Ward in Turkey. Int J Clin Pharm. 2018;40(2):360–367. doi:10.1007/s11096-017-0585-5
12. Apikoglu-Rabus S, Yesilyaprak G, Izzettin FV. Drug-related problems and pharmacist interventions in a cohort of patients with asthma and chronic obstructive pulmonary disease. Respir Med. 2016;120:109–115. doi:10.1016/j.rmed.2016.10.006
13. Bosnak AS, Birand N, Diker O, Abdi A, Basgut B. The role of the pharmacist in the multidisciplinary approach to the prevention and resolution of drug-related problems in cancer chemotherapy. J Oncol Pharm Pract. 2018. doi:10.1177/1078155218786048
14. Demirkan K, Bayraktar-Ekincioglu A, Gulhan-Halil M, Abbasoglu O. Assessment of drug administration via feeding tube and the knowledge of health-care professionals in a university hospital. Eur J Clin Nutr. 2017;71(2):164–168. doi:10.1038/ejcn.2016.147
15. Halvorsen KH, Ruths S, Granas AG, Viktil KK. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scand J Prim Health Care. 2010;28(2):82–88. doi:10.3109/02813431003765455
16. Korcegez EI, Sancar M, Demirkan K. Effect of a pharmacist-led program on improving outcomes in patients with type 2 diabetes mellitus from northern cyprus: a randomized controlled trial. J Manag Care Spec Pharm. 2017;23(5):573–582. doi:10.18553/jmcp.2017.23.5.573
17. Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium–description of the impact on a geriatric unit. Ann Pharmacother. 2006;40(4):720–728. doi:10.1345/aph.1G515
18. Wilson S, Wahler R, Brown J, Doloresco F, Monte SV. Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Care. 2011;28(5):316–320. doi:10.1177/1049909110391080
19. Selcuk A, Sancar M, Okuyan B, Demirtunc R, Izzettin FV. The potential role of clinical pharmacists in elderly patients during hospital admission. Pharmazie. 2015;70(8):559–562.
20. Somers A, Robays H, De Paepe P, Van Maele G, Perehudoff K, Petrovic M. Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital. Clin Interv Aging. 2013;8:703–709. doi:10.2147/CIA.S42162
21. Van der Linden L, Hias J, Dreessen L, et al. Medication review versus usual care to improve drug therapies in older inpatients not admitted to geriatric wards: a quasi-experimental study (RASP-IGCT). BMC Geriatr. 2018;18(1):155. doi:10.1186/s12877-018-0843-y
22. LA U, Arun M, Ege M, et al. Media Pharma İnteraktif İlaç Bilgi Kaynağı 2018. In: Ustunes L, editor GEMAŞ Genel Mühendislik Mekanik Sanayi ve Ticaret A.Ş. İzmir, Turkey; 2018.
23. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–2246. doi:10.1111/jgs.13702
24. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–218. doi:10.1093/ageing/afu145
25. Allemann SS, van Mil JW, Botermann L, Berger K, Griese N, Hersberger KE. Pharmaceutical care: the PCNE definition 2013. Int J Clin Pharm. 2014;36(3):544–555. doi:10.1007/s11096-014-9933-x
26. van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38(5):859–867. doi:10.1345/aph.1D182
27. Baijens LW, Clave P, Cras P, et al. European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–1428. doi:10.2147/CIA.S107750
28. Bo M, Gibello M, Brunetti E, et al. Prevalence and predictors of inappropriate prescribing according to the screening tool of older people’s prescriptions and screening tool to alert to right treatment version 2 criteria in older patients discharged from geriatric and internal medicine wards: a prospective observational multicenter study. Geriatr Gerontol Int. 2019;19(1):5–11.
29. Piau A, Huet Y, Gallini A, Andre L, Vellas B, Nourhashemi F. Optimization of drug therapy in elderly individuals admitted to a geriatric unit. Clin Interv Aging. 2017;12:1691–1696. doi:10.2147/CIA.S132309
30. Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med. 1991;114(11):956–966.
31. Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079–2086. doi:10.2147/CIA.S71178
Article Sidebar
Published
Mar 16, 2022
Article Details
How to Cite
Khaled Obaid Hammad Albathali , Abdullah Nazal Mohammed Alharbi , Abdulrazaq Ahmed Hattab Alanazi , Mamdouh Saud Dahi Alfadhli , Ahmad Khalaf Ramadan Alanazi , Naif Sulaiman Alharbi. (2022). Evaluating Pharmacist Interventions and Commonly Used Medications in the Geriatric Ward of a Teaching Hospital: A Retrospective Analysis. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 861-867. https://doi.org/10.53555/jptcp.v29i04.5562
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Khaled Obaid Hammad Albathali , Abdullah Nazal Mohammed Alharbi , Abdulrazaq Ahmed Hattab Alanazi , Mamdouh Saud Dahi Alfadhli , Ahmad Khalaf Ramadan Alanazi , Naif Sulaiman Alharbi. (2022). Evaluating Pharmacist Interventions and Commonly Used Medications in the Geriatric Ward of a Teaching Hospital: A Retrospective Analysis. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 861-867. https://doi.org/10.53555/jptcp.v29i04.5562