MINIMIZATION OF DRUG RELATED PROBLEMS IN ELDERLY PATIENTS: A NEW INTERVENTIONAL PHARMACEUTICAL CARE PLAN

Abstract

Older patients are at high risk for experiencing inappropriate drug use, because they are more liable to multiple diseases and more expected to take several medications. This may have impact on their physiological functions, cognition,increase the risk for drug interactions and medication errors. Inappropriate medication use in elderly patients can be evaluated by using either explicit (criterion-based) or implicit (judgment-based) criteria. “Beers criteria,STOPP (screening tool of older person’s prescriptions) & START (screening tool to alert to right treatment) and medication appropriateness index (MAI)” are widely used to detect and modify inappropriate medication in the elderly. Clinical pharmacists offer safe medication use by providing completesupervision to patients and medical staff. However, geriatric medications still abit vague in pharmaceutical care. Aim of the work The aim of the current study is to detect, evaluate and minimize drug related problems in elderly patients admitted to Department of Geriatrics, Ain Shams University.

Patients and methods The study was carried out in Department of Geriatrics, Ain Shams University on 300 elderly patients who were divided into two groups. Control group contained 150 patients who received standard care without pharmaceutical care in the health care team. Patients in the control group were examined for the inappropriate medication use. The obtained data were evaluated and used to put a prospective plan of pharmaceutical intervention. Additional 150 patients were enrolled in the intervention group and they are legible to enhanced service provided by clinical pharmacists. Primary outcome measures were done using Beers criteria and STOPP & START criteria, while secondary outcome measures were done using MAI.

Results The present study has shown that there are no significant differences in age and sex between control and intervention groups. Hypertension, diabetes and ischemic heart diseases were the most frequent recorded diseases. More than 50 % of patients in both groups were taking more than 10 drugs. The percentages of patients in control group suffered from inappropriate prescribing according to STOPP & START criteria and Beers criteria (35.3, 64.7 and19.3 respectively) were significantly higher than in intervention group (9.3, 36.7 and 6.6 respectively). MAI score per patient was significantly decreased from 17 to 4 by pharmaceutical intervention. Moreover, the highest number of inappropriate drugs was observed in drug-drug interaction followed by using drugs with incorrect directions then ineffective drugs. Finally, there were significant correlations between MAI score and polypharmacy and between MAI score and number of morbidities. However, no significant correlations were detected between MAI score per patient and age.

Conclusions Based on STOPP & START and Beers criteria, it can be concluded that percentages of patients in control group who were treated inappropriately