title: Impact of the pharmacist medication review services on drug-related problems and potentially inappropriate prescribing of renally cleared medications in residents of aged care facilities.
abstract: BACKGROUND
  Drug-related problems (DRPs) are common in aged care facilities and few studies have been conducted to determine the impact of the pharmacist-conducted medication review services. Studies determining the prevalence of chronic kidney disease (CKD) and data regarding inappropriate prescribing of renally cleared medications in aged care facilities in Australia are also lacking.
  
  
  OBJECTIVE
  To investigate the number and nature of DRPs identified and recommendations made by pharmacists in residents of aged care facilities. To determine the prevalence of CKD and estimate the magnitude of inappropriate prescribing of renally cleared medications in residents of aged care facilities.
  
  
  METHODS
  DRPs identified and recommendations made by pharmacists were classified using the adapted version of the DOCUMENT classification system. The modification of diet in renal disease formula was used to estimate the prevalence of CKD, and the Cockcroft-Gault formula was used to estimate the magnitude of inappropriate prescribing of renally cleared medications.
  
  
  RESULTS
  Over 98 % of residents of aged care facilities had at least one DRP. Most (83.8 %) recommendations made by accredited pharmacists to resolve DRPs were accepted by general practitioners. CKD was prevalent in 48 % of residents, and inappropriate prescribing of renally cleared medications was identified in 28 (16 %) residents with CKD.
  
  
  CONCLUSIONS
  DRPs are common in aged care facilities and the impact of medication review services appears to be high. CKD is also common among residents of aged care facilities, and inappropriate prescribing of renally cleared medications was also prevalent, warranting attention to regular renal function monitoring and appropriate drug and dose selection in residents of aged care facilities.
authors.affiliation: School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia, Pankti.Gheewala@utas.edu.au.
authors.forename: Pankti A
authors.initials: PA
authors.lastname: Gheewala
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Peterson
authors.forename: Colin M
authors.initials: CM
authors.lastname: Curtain
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Nishtala
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hannan
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Castelino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010593:Pharmaceutical Services / Q000706:statistics & numerical data; D010595:Pharmacists; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000453:epidemiology