Abstract
Purpose
Potentially inappropriate medications (PIMs) have been associated with a greater risk of adverse drug events and hospitalizations. To reduce PIMs use, a family health team (FHT) implemented a knowledge translation (KT) strategy that included a pharmacist-physician intervention model based on alerts from a computerized alert system (CAS).
Methods
Our pragmatic, single-site, pilot study was conducted in an FHT clinic in Quebec, Canada. We included community-dwelling older adults (≥ 65 years), with at least 1 alert for selected PIMs and a medical appointment during the study period. PIMs were selected from the Beers and STOPP criteria. The primary outcome was PIMs cessation, decreased dose, or replacement. The secondary outcome was the clinical relevance of the alerts as assessed by the pharmacists.
Results
During the 134 days of the study, the CAS screened 369 individuals leading to the identification of 65 (18%) patients with at least 1 new alert. For those 65 patients, the mean age was 77 years, men accounted for 29% of the group and 55% were prescribed 10 or more drugs. One or more clinically relevant alerts were generated for 27 of 65 included patients for an overall clinical relevance of the alerts of 42%. Of the 27 patients with at least 1 relevant alert, 17 (63%) had at least 1 medication change as suggested by the pharmacist.
Conclusion
An interdisciplinary pharmacist-physician intervention model, based on alerts generated by a CAS, reduced the use of PIMs in community-dwelling older adults followed by an FHT.
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Acknowledgments
The authors are grateful to Martin St-Jean for his help in the data transfer from the Electronic Medical Record to the Computerized Alert System and to Danielle Buch, a medical writer, for a quick edit of the manuscript.
Funding
This study was funded partially through a grant received from the Fondation Vitae of the CIUSSS de l’Estrie-CHUS. The funding source had no involvement in the study design, data collection, analysis, or interpretation; the writing of the report; or the decision to submit the report for publication.
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Benoit Cossette, Ryeyan Taseen, Jacynthe Roy-Petit, Geneviève Ricard, and Jean-François Éthier designed the study; Benoit Cossette, Ryeyan Taseen, Jacynthe Roy-Petit, Martine Grondin, François Goyer, and Jean-François Éthier acquired and analyzed the data; interpreted the data; Benoit Cossette and Ryeyan Taseen drafted the manuscript; Jacynthe Roy-Petit, Marie-Pier Villemure, Martine Grondin, Geneviève Ricard, François Goyer, Caroline Blanchard, Thomas Joly-Mischlich, and Jean-François Éthier critically revised the manuscript.
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This study was approved by the CIUSSS de l’Estrie-CHUS Research Ethics Board.
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Cossette, B., Taseen, R., Roy-Petit, J. et al. A pharmacist-physician intervention model using a computerized alert system to reduce high-risk medication use in primary care. Eur J Clin Pharmacol 75, 1017–1023 (2019). https://doi.org/10.1007/s00228-019-02660-x
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DOI: https://doi.org/10.1007/s00228-019-02660-x