The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing. A randomized controlled trial.
The impact of clinical pharmacists' consultations on geriatric drug prescribing was studied in a prospective randomized controlled trial of patients 65 years of age and over discharged on 3 or more medications for chronic conditions from a 450-bed community hospital. The pharmacists provided consultation to experimental patients and their physicians at hospital discharge and at periodic intervals for 3 months postdischarge. Using a standardized tool, a physician-pharmacist panel, blinded to study group assignment of patients, evaluated the appropriateness of prescribing for a random sample of 236 patients. Eighty-eight percent had at least one or more clinically significant drug problems, and 22% had at least one potentially serious and life-threatening problem. Drug-therapy problems were divided into six categories: 1) inappropriate choice of therapy; 2) dosage; 3) schedule; 4) drug-drug interactions; 5) therapeutic duplication; and 6) allergy. Experimental patients were less likely to have one or more prescribing problems in any of the categories (P = 0.05) or in the appropriateness (P = 0.02) or dosage (P = 0.05) categories. A summary score, measuring the appropriateness of the patient's total drug regimen, indicated that experimental patients' regimens were more appropriate than those of controls (P = 0.01). Results of this trial reveal that clinical pharmacists can improve the appropriateness of geriatric drug prescribing in outpatient settings.
Lipton
H L
HL
Division of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco.
Bero
L A
LA
Bird
J A
JA
McPhee
S J
SJ
D000368:Aged; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D010607:Pharmacy Service, Hospital; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation; D012495:San Francisco