title: Effects of pharmacists' interventions on appropriateness of prescribing and evaluation of the instruments' (MAI, STOPP and STARTs') ability to predict hospitalization--analyses from a randomized controlled trial.
abstract: BACKGROUND
  Appropriateness of prescribing can be assessed by various measures and screening instruments. The aims of this study were to investigate the effects of pharmacists' interventions on appropriateness of prescribing in elderly patients, and to explore the relationship between these results and hospital care utilization during a 12-month follow-up period.
  
  
  METHODS
  The study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalization was investigated, was used. The criteria from the instruments MAI, STOPP and START were applied retrospectively to the 368 study patients (intervention group (I) n = 182, control group (C) n = 186). The assessments were done on admission and at discharge to detect differences over time and between the groups. Hospital care consumption was recorded and the association between scores for appropriateness, and hospitalization was analysed.
  
  
  RESULTS
  The number of Potentially Inappropriate Medicines (PIMs) per patient as identified by STOPP was reduced for I but not for C (1.42 to 0.93 vs. 1.46 to 1.66 respectively, p<0.01). The number of Potential Prescription Omissions (PPOs) per patient as identified by START was reduced for I but not for C (0.36 to 0.09 vs. 0.42 to 0.45 respectively, p<0.001). The summated score for MAI was reduced for I but not for C (8.5 to 5.0 and 8.7 to 10.0 respectively, p<0.001). There was a positive association between scores for MAI and STOPP and drug-related readmissions (RR 8-9% and 30-34% respectively). No association was detected between the scores of the tools and total re-visits to hospital.
  
  
  CONCLUSIONS
  The interventions significantly improved the appropriateness of prescribing for patients in the intervention group as evaluated by the instruments MAI, STOPP and START. High scores in MAI and STOPP were associated with a higher number of drug-related readmissions.
authors.affiliation: Division of Pharmacokinetics and Drug Therapy, Department of Pharmaceutical Biosciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden. Ulrika.gillespie@akademiska.se
authors.forename: Ulrika
authors.initials: U
authors.lastname: Gillespie
authors.forename: Anna
authors.initials: A
authors.lastname: Alassaad
authors.forename: Margareta
authors.initials: M
authors.lastname: Hammarlund-Udenaes
authors.forename: Claes
authors.initials: C
authors.lastname: Mörlin
authors.forename: Dan
authors.initials: D
authors.lastname: Henrohn
authors.forename: Maria
authors.initials: M
authors.lastname: Bertilsson
authors.forename: Håkan
authors.initials: H
authors.lastname: Melhus
mesh_terms: D000369:Aged, 80 and over; D006299:Health Services for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control*; D054539:Medication Therapy Management / Q000592:standards*; D010595:Pharmacists; D010818:Practice Patterns, Physicians' / Q000592:standards*