title: Impact of an enhanced pharmacy discharge service on prescribing appropriateness criteria: a randomised controlled trial.
abstract: BACKGROUND
  Older people are at increased risk of drug-related problems (DRPs) caused by inappropriate use or underuse of medications which may be increased during care transitions.
  
  
  OBJECTIVE
  To examine the effects of applying a validated prescribing appropriateness criteria-set during medication review in a cohort of older (≥65 years) Australians at the time of discharge from hospital.
  
  
  METHODS
  Private hospital and homes of older patients in Sydney, Australia.
  
  
  METHODS
  Cognitively well English speaking patients aged 65 years or over taking five or more medications were recruited. A prescribing appropriateness criteria-set and SF-36 health-related quality of life health (HRQoL) survey were applied to all patients at discharge. Patients were then randomly assigned to receive either usual care (control, n = 91) or discharge medication counselling and a medication review by a clinical pharmacist (intervention, n = 92). Medication review recommendations were sent to the general practitioners of intervention group patients. All patients were followed up at 3 months post discharge, where the prescribing appropriateness criteria-set was reapplied and HRQoL survey repeated. MAIN OUTCOME MEASURES change in the number of prescribing appropriateness criteria met; change in HRQoL; number and causes of DRPS identified by medication review; intervention patient medication recommendation implementation rates.
  
  
  RESULTS
  There was no significant difference in the number of criteria applicable and met in intervention patients, compared to control patients, between follow-up and discharge (0.09 ≤ p ≤ 0.97). While the difference between groups was positive at follow-up for SF-36 scores, the only domain that reached statistical significance was that for vitality (p = 0.04). Eighty-eight intervention patient medication reviews identified 750 causes of DRPs (8.5 ± 2.7 per patient). No causes of DRPs were identified in four patients. Of these causes, 76.4 % (573/750) were identified by application of the prescribing appropriateness criteria-set. GPs implemented a relatively low number (42.4 %, 318/750) of recommendations.
  
  
  CONCLUSIONS
  Application of a prescribing appropriateness criteria-set during medication review in intervention patients did not increase the number of criteria met, nor result in a significant improvement in HRQoL. Higher recommendation implementation rates may require additional facilitators, including a higher quality of collaboration.
authors: Faculty of Pharmacy, The University of Sydney, A15 Science Road, Sydney, Camperdown, NSW, 2006, Australia. ben.basger@sydney.edu.au.
authors: Benjamin J
authors: BJ
authors: Basger
authors: Faculty of Pharmacy, The University of Sydney, A15 Science Road, Sydney, Camperdown, NSW, 2006, Australia.
authors: Rebekah J
authors: RJ
authors: Moles
authors: Faculty of Pharmacy, The University of Sydney, A15 Science Road, Sydney, Camperdown, NSW, 2006, Australia.
authors: Timothy F
authors: TF
authors: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D019338:Polypharmacy; D011788:Quality of Life
keywords: Australia; DRPs; Drug-related problems; Inappropriate prescribing; Overprescribing; Prescribing appropriateness criteria; Private hospital; Underprescribing