title: Identification of drug-related problems of elderly patients discharged from hospital.
abstract: BACKGROUND
  Drug-related problems (DRP) following hospital discharge are common among elderly patients using multiple drugs for the treatment of chronic diseases. The aim of this study was to investigate the occurrence of DRP in these patients using a specific tool for the identification of DRP by community pharmacists.
  
  
  METHODS
  An observational study involving 340 patients aged over 60 years using at least five prescription drugs and discharged from hospital. The occurrence of DRP was assessed by means of an identification tool specifically developed for use by community pharmacists, including a semistructured patient interview and a checklist of common DRP.
  
  
  RESULTS
  In total, 992 potential DRP were observed in the 340 patients (mean 2.9 ± 1.7). No drug prescribed but clear indication, an unnecessarily long duration of treatment, dose too low, and incorrect drug selection were the DRP most commonly observed. Ten percent of DRP occurring in 71 patients were drug-drug interactions. The number of DRP was related to the number of drugs prescribed. Frequently occurring DRP found using the patient interview were fear of side effects and no or insufficient knowledge of drug use. Medication of patients discharged from the pulmonary department and of those with type 2 diabetes was particularly associated with occurrence of DRP.
  
  
  CONCLUSIONS
  Following hospital discharge, DRP occur frequently among elderly patients using five or more drugs for the treatment of chronic disease. The number of DRP increased with the number of drugs used. An important task for community pharmacists is to identify, resolve, and prevent the occurrence of DRP among this patient group. Since DRP are associated with an increased risk of hospital readmissions, morbidity, and mortality, it is very important to develop intervention strategies to resolve and prevent DRP.
authors: Department of Clinical Pharmacology and Pharmacy, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors: Abeer
authors: A
authors: Ahmad
authors: Department of Clinical Pharmacology and Pharmacy, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors: M Ruth
authors: MR
authors: Mast
authors: Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors: Giel
authors: G
authors: Nijpels
authors: Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors: Petra Jm
authors: PJ
authors: Elders
authors: Departments of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors: Jacqueline M
authors: JM
authors: Dekker
authors: Department of Clinical Pharmacology and Pharmacy, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors: Jacqueline G
authors: JG
authors: Hugtenburg
keywords: community pharmacy; discharge from hospital; drug-related problems; elderly