title: Effectiveness of the medication safety review clinics for older adults prescribed multiple medications.
abstract: OBJECTIVE
  Polypharmacy is common among Taiwanese older adults. We aim to determine the effectiveness of the medication safety review clinics (MSRCs) for solving drug-related problems (DRPs) among older adults prescribed multiple medications.
  
  
  METHODS
  This prospective case-series intervention study was conducted at the outpatient department of the National Taiwan University Hospital and its BeiHu Branch. Older adults (≥65 years) who either had been prescribed ≥8 chronic medications (drugs prescribed for ≥28 days) or had visited ≥3 different physicians during the 3-month screening period were enrolled (N = 193). DRPs were identified after baseline assessments from a team of geriatricians and pharmacists. Prescribers were contacted with proposed interventions to be administered within 12 weeks. Problem-solving rates (PSRs) at both Week 12 and Week 24 visits were recorded. Stepwise multivariate logistic regression was applied to identify correlates of having at least one unsolved DRP at 24 weeks. Participants (N = 139) who completed four visits to the MSRCs were analyzed.
  
  
  RESULTS
  The mean age was 75.6 ± 6.1 years and 56% of them were men. The mean chronic medication per patient was 9.0 ± 3.1, and the mean DRP per patient was 2.1 ± 1.5. The PSR was 76% at Week 12 and 87% at Week 24. Thirty-two patients (22%) had at least one unsolved DRP. Correlates of the unsolved DRP included a higher geriatric depression scale, a higher chronic medication per patient, and a higher DRP per patient. The mean chronic medication per patient (9.0 vs. 8.6, p < 0.05) decreased, and the number of participants rating good or better health status improved from 22% to 38% in 24 weeks (p < 0.001). Participants were highly satisfied (96% at all times) with the service.
  
  
  CONCLUSIONS
  DRPs were common in geriatric outpatients taking multiple medications and most were solved with appropriate interventions. The MSRC service may improve prescription quality in Taiwan if widely available.
authors: Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: doctord6226@yahoo.com.
authors: Ding-Cheng
authors: DC
authors: Chan
authors: Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Jen-Hau
authors: JH
authors: Chen
authors: Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
authors: Chiung-Jung
authors: CJ
authors: Wen
authors: Department of Pharmacy, Taipei City Hospital Songde Branch, Taipei, Taiwan.
authors: Lee-Shu
authors: LS
authors: Chiu
authors: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: scwu@mail2000.com.tw.
authors: Shwu-Chong
authors: SC
authors: Wu
mesh_terms: D000368:Aged; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management; D010045:Outpatients; D019338:Polypharmacy; D013624:Taiwan
keywords: aged; drug-related problems; medication review; outpatient; polypharmacy