title: Drug-Related Problems Identified in a Sample of Portuguese Institutionalised Elderly Patients and Pharmacists' Interventions to Improve Safety and Effectiveness of Medicines.
abstract: BACKGROUND
  Currently, people live longer but often with poor quality of life. The decrease in healthy life-years is partly attributable to the institution of polypharmacy to treat various comorbidities.
  
  
  OBJECTIVE
  The objectives of the study were to determine the prevalence and nature of drug-related problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist's intervention.
  
  
  METHODS
  An exposure cohort was constituted in three Portuguese nursing homes, where all polypharmacy (five or more medicines) elderly patients (≥65 years of age) were analysed and then a random stratified sample was extracted to be subject to an intervention. Clinical and therapeutic data were collected and analysed for DRPs and classified according to the II Granada Consensus, by a pharmacist-led team. The intervention was the formulation of a pharmacist's recommendations to prescribers addressing clinically relevant DRPs, along with suggestions for therapy changes.
  
  
  RESULTS
  The initial sample included 126 elderly patients taking 1332 medicines, where 2109 DRPs were identified. The exposure cohort included 63 patients, with comparable baseline data (p > 0.005). Manifest DRPs occurred in 31.7 % of the intervention group (mainly quantitative ineffectiveness-DRP 4), whereas potential DRPs were identified in 100 % of patients (mainly non-quantitative unsafe-DRP 5). Amongst the DRPs identified, 584 (56.7 %) were reported to prescribers (all types of DRPs) and 113 (11 %) to nurses (only non-quantitative ineffectiveness-DRP 3). A total of 539 pharmacist recommendations were presented to physicians, corresponding to 62 letters sent by mail, each including an average of 8.7 recommendations to solve DRPs present in intervention group (IG) patients. There was a high non-response rate (n = 34 letters; 54.8 %; containing 367 pharmacist recommendations; 68.1 %) and amongst recommendations receiving feedback, only 8.7 % of pharmacist recommendations made were accepted (n = 15). Positive responses were significantly associated with a lower number of recommendations made, whereas a higher number of recommendations increased the odds of no response (p < 0.001).
  
  
  CONCLUSIONS
  A pharmacist-led medication review proved useful in identifying DRPs in elderly polypharmacy nursing home residents. Stronger bonds must be developed between healthcare professionals to increase patient safety in the vulnerable institutionalised elderly population.
authors.affiliation: Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal. alvesdacosta.f@gmail.com.|Registo Oncológico Regional Sul (ROR-Sul), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal. alvesdacosta.f@gmail.com.|ISCSEM, Campus Universitário, Quinta da Granja Monte de Caparica, 2829-511, Caparica, Portugal. alvesdacosta.f@gmail.com.
authors.forename: Filipa Alves
authors.initials: FA
authors.lastname: da Costa
authors.affiliation: Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Silvestre
authors.affiliation: Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Periquito
authors.affiliation: Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal.
authors.forename: Clara
authors.initials: C
authors.lastname: Carneiro
authors.affiliation: Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Oliveira
authors.affiliation: Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Fernandes
authors.affiliation: Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Cavaco-Silva