title: Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome.
abstract: Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions.
  
  
  
  Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients.
  
  
  
  A monocentric, prospective controlled trial was undertaken at the geriatric wards of a large university hospital. Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review, upon which recommendations were provided to the treating physicians. The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission. Secondary outcomes included RASP-identified potentially inappropriate medications (PIMs), the number of Emergency Department (ED) visits and quality of life (QOL) registered up to 3 months after discharge.
  
  
  
  On average, patients (n = 172) took 10 drugs on admission and were 84.5 years (standard deviation 4.8) of age. More drugs were discontinued or reduced in dose in the intervention group {control vs.intervention:median (interquartile range [IQR]) 3 (2-5) vs. 5 (3-7); p < 0.001}. More PIMs were discontinued in the intervention group, leading to less PIM at discharge [control vs.intervention:median (IQR) 2 (1-3) vs. 0.5 (0-1); p < 0.001]. No signal of harm was seen, and a significant improvement of QOL and less ED visits without hospitalization were observed.
  
  
  
  The combined intervention safely reduced drug use in very old inpatients and outperformed usual geriatric care. An increased QOL was seen, as well as a trend towards less ED visits. ClinicalTrials.gov Identifier: NCT01513265.
authors.affiliation: Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. lorenz.vanderlinden@uzleuven.be.|Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium. lorenz.vanderlinden@uzleuven.be.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Van der Linden
authors.affiliation: Pharmacy Department, Jessa Hospital, Hasselt, Belgium.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Decoutere
authors.affiliation: Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
authors.forename: Karolien
authors.initials: K
authors.lastname: Walgraeve
authors.affiliation: Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Louvain, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
authors.affiliation: Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium.|Department of Clinical and Experimental Medicine, KU Leuven, Louvain, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Flamaing
authors.affiliation: Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.|Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: Spriet
authors.affiliation: Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium.|Department of Clinical and Experimental Medicine, KU Leuven, Louvain, Belgium.
authors.forename: Jos
authors.initials: J
authors.lastname: Tournoy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010595:Pharmacists; D019338:Polypharmacy; D000067561:Potentially Inappropriate Medication List; D011446:Prospective Studies; D011788:Quality of Life; D011908:Rationalization