Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial.
OBJECTIVE
To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management (GEM) care on the appropriateness of prescribing.


METHODS
Randomized, controlled trial, with the patient as unit of randomization.


METHODS
Acute GEM unit.


METHODS
Two hundred three patients aged 70 and older.


METHODS
Pharmaceutical care provided from admission to discharge by a specialist clinical pharmacist who had direct contacts with the GEM team and patients.


METHODS
Appropriateness of prescribing on admission, at discharge, and 3 months after discharge, using the Medication Appropriateness Index (MAI), Beers criteria, and Assessing Care of Vulnerable Elders (ACOVE) underuse criteria and mortality, readmission, and emergency visits up to 12 months after discharge.


RESULTS
Intervention patients were significantly more likely than control patients to have an improvement in the MAI and in the ACOVE underuse criteria from admission to discharge (odds ratio (OR)=9.1, 95% confidence interval (CI)=4.2-21.6 and OR=6.1, 95% CI=2.2-17.0, respectively). The control and intervention groups had comparable improvements in the Beers criteria.


CONCLUSIONS
Pharmaceutical care provided in the context of acute GEM care improved the appropriate use of medicines during the hospital stay and after discharge. This is an important finding, because only limited data exist on the effect of various strategies to improve medication use in elderly inpatients. The present approach has the potential to minimize risk and improve patient outcomes.
Spinewine
Anne
A
Center for Clinical Pharmacy, School of Pharmacy, Université Catholique de Louvain, Brussels, Belgium. anne.spinewine@facm.ucl.ac.be
Swine
Christian
C
Dhillon
Soraya
S
Lambert
Philippe
P
Nachega
Jean B
JB
Wilmotte
Léon
L
Tulkens
Paul M
PM
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D016330:Frail Elderly; D005853:Geriatrics; D006757:Hospital Units; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010348:Patient Care Team; D010607:Pharmacy Service, Hospital