title: Impact of a Clinical Pharmacy Specialist in an Emergency Department for Seniors.
abstract: OBJECTIVE
  This study assesses outcomes associated with the implementation of an emergency department (ED) for seniors in which a clinical pharmacy specialist, with specialized geriatric training that included medication management training, is a key member of the ED care team.
  
  
  METHODS
  This was a retrospective cohort analysis of patients aged 65 years or older who presented at an ED between November 1, 2012, and May 31, 2013. Three groups of seniors were assessed: treated by the clinical pharmacy specialist in the ED for seniors, treated in the ED for seniors but not by the clinical pharmacy specialist, and not treated in the ED for seniors. Outcomes included rates of an ED return visit, mortality and hospital admissions, and follow-up total health care costs. Multivariable regression modeling was used to adjust for any potential confounders in the associations between groups and outcomes.
  
  
  RESULTS
  A total of 4,103 patients were included, with 872 (21%) treated in the ED for seniors and 342 (39%) of these treated by the clinical pharmacy specialist. Groups were well matched overall in patient characteristics. Patients who received medication review and management by the clinical pharmacy specialist did not experience a reduction in ED return visits, mortality, cost of follow-up care, or hospital admissions compared with the other groups. Of the patients treated by the clinical pharmacy specialist, 154 (45.0%) were identified as having at least 1 medication-related problem.
  
  
  CONCLUSIONS
  Although at least 1 medication-related problem was identified in almost half of patients treated by the clinical pharmacy specialist in the ED for seniors, incorporation of a clinical pharmacy specialist into the ED staff did not improve clinical outcomes.
authors.affiliation: Pharmacy Department, Kaiser Permanente Colorado, Lafayette, CO. Electronic address: paul.b.shaw@kp.org.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Shaw
authors.affiliation: Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO.
authors.forename: Thomas
authors.initials: T
authors.lastname: Delate
authors.affiliation: Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO.
authors.forename: Alfred
authors.initials: A
authors.lastname: Lyman
authors.affiliation: Pharmacy Department, Lutheran Medical Center, Wheat Ridge, CO.
authors.forename: Jody
authors.initials: J
authors.lastname: Adams
authors.affiliation: Pharmacy Department, Kaiser Permanente Colorado, Denver, CO.
authors.forename: Heather
authors.initials: H
authors.lastname: Kreutz
authors.affiliation: Pharmacy Department, Kaiser Permanente Colorado, Englewood, CO.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Sanchez
authors.affiliation: Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Dowd
authors.affiliation: Quality Department, Kaiser Permanente Colorado, Aurora, CO.
authors.forename: Wendolyn
authors.initials: W
authors.lastname: Gozansky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003120:Colorado; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D010607:Pharmacy Service, Hospital; D012189:Retrospective Studies; D000078329:Workforce