title: Drug-related problems in institutionalized, polymedicated elderly patients: opportunities for pharmacist intervention.
abstract: BACKGROUND
  An aging population and the increasing prevalence of chronic diseases have led to the increased use of medicines. Portugal is one of the European countries where more medicines are consumed and the associated expense is higher. Medicines are associated with enormous health benefits but also with the potential to cause illness and death. A drug related problem (DRP) is an "an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes". In the U.S., they represent the 4th-6th leading cause of death and have an estimated cost of 130 billion dollars. Moreover, many of these DRP can be avoided. Elderly are at increased risk of DRP due to multiple factors: pluripathology and consequent polypharmacy, complex dosing regimens, pharmacokinetic/pharmacodynamic and functional/cognitive changes. Therefore, this population would be the one who would benefit most from the prevention, detection and control of DRP. The role of the pharmacist as an integral element of health care has been recognized by various international and European organizations. Providing pharmaceutical care as a patient-centered activity, focusing on their needs related to pharmacotherapy, contributes to guarantee that drug expenditure is a good investment, with benefits that outweigh potential risks.
  
  
  OBJECTIVE
  To evaluate the need for pharmaceutical care implementation in institutionalized, polymedicated elderly.
  
  
  METHODS
  Descriptive observational cross-sectional study carried out in six Portuguese nursing homes, selected by convenience, in November-December 2013. Each institution selected up to six patients, according to the following inclusion criteria: age ≥65 years, number of medications ≥5 and ability to respond to an interview. All participants signed an informed consent form. Pharmacists carried out a structured interview with each patient and consulted patient medical records to gather demographic data and information on health problems and medications used. To identify DRP, official drug information sources were consulted, and the STOPP and START tool was used. The ATC, the ICD-10 and the PCNE Classification V 6.2 classification systems were used for medicines, health problems and DRP classifications, respectively. For each medicine used, the cheapest equivalent available was also identified.
  
  
  RESULTS
  The sample included 31 elderly (64.52 % female, mean age 81.65 ± 6.86). On average, subjects presented a mean of 7.94 ± 2.76 health problems with diseases of the circulatory system being the most common. The sample used a median of ten medicines per patient. Those medicines working in the cardiovascular, nervous and digestive systems were the most frequently used (29.75, 29.43 and 19.30 %, respectively). A total of 484 DRP (median: 15 DRP/patient) was found. The most common DRP were Adverse Drug Event, non-allergic (49.51 %), Drug treatment more costly than necessary (19.11 %), Effect of drug treatment not optimal (14.82 %) and Unnecessary drug treatment (6.16 %). The most cost-effective proposal, would lead to a saving of <euro> 3,950/year in the studied sample.
  
  
  CONCLUSIONS
  These results reinforce the need for the implementation of pharmaceutical care services to institutionalized elderly, necessary to improve medicines efficacy and safety, better clinical outcomes and cost reduction.
authors: SerFarma, Ltd, Coimbra, Portugal.
authors: Cristina
authors: C
authors: Silva
authors: Célia
authors: C
authors: Ramalho
authors: Isabel
authors: I
authors: Luz
authors: Joaquim
authors: J
authors: Monteiro
authors: Paula
authors: P
authors: Fresco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D007326:Institutionalization / Q000379:methods* / Q000592:standards; D008297:Male; D009735:Nursing Homes / Q000592:standards; D010593:Pharmaceutical Services / Q000592:standards; D010595:Pharmacists / Q000592:standards; D019338:Polypharmacy; D024382:Professional Role
references: Drugs Aging. 2012 May 1;29(5):359-76
references: 22550966
references: JAMA. 2006 Oct 18;296(15):1858-66
references: 17047216
references: Ann Emerg Med. 2002 Mar;39(3):258-67
references: 11867978
references: Br J Clin Pharmacol. 2004 Jan;57(1):6-14
references: 14678335
references: Am J Geriatr Pharmacother. 2010 Feb;8(1):63-72
references: 20226393
references: J Am Med Dir Assoc. 2013 Apr;14(4):265-9
references: 23211534
references: J Clin Hypertens (Greenwich). 2008 Apr;10(4):260-71
references: 18401223
references: Fam Pract. 2000 Jun;17(3):261-7
references: 10846147
references: Eur J Clin Pharmacol. 2006 May;62(5):387-93
references: 16604344
references: Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
references: 18218287
references: Drugs Aging. 2012 Jan 1;29(1):15-30
references: 22191720
references: J Clin Pharm Ther. 2007 Apr;32(2):113-21
references: 17381661
references: Int J Clin Pharm. 2011 Jun;33(3):549-57
references: 21442282
references: Drug Saf. 2007;30(1):81-8
references: 17194173
references: J Gerontol A Biol Sci Med Sci. 2012 Jun;67(6):698-704
references: 22219520
references: Drugs Aging. 2011 Jul 1;28(7):509-18
references: 21721596
references: Age Ageing. 2001 May;30(3):205-11
references: 11443021
references: J Am Med Dir Assoc. 2011 May;12(4):308-11
references: 21527173
references: Arch Intern Med. 1997 Oct 13;157(18):2089-96
references: 9382665
references: Ann Pharmacother. 2002 Sep;36(9):1331-6
references: 12196047
references: Pharm World Sci. 2002 Apr;24(2):46-54
references: 12061133