Pharmacist intervention acceptance for the reduction of potentially inappropriate drug prescribing in acute psychiatry
Background Prescribing for the elderly is challenging. A previous observational study conducted in our geriatric psychiatry admission unit (GPAU) using STOPP/START criteria showed a high number of potentially inappropriate drug prescriptions (PIDPs). A clinical pharmacist was added to our GPAU as a strategy to reduce PIDPs. Objective The objective of the present study was to assess the impact of a clinical pharmacist on PIDPs by measuring acceptance rates of pharmacist interventions (PhIs). Setting This study was conducted at the GPAU of Lausanne University Hospital. Method The clinical pharmacist attended four GPAU meetings weekly. Complete medication reviews were performed daily. The clinical pharmacist conducted standard analyses based on clinical judgment and STOPP/START criteria assessment. A PhI was generated when a PIDP was detected. When a PhI was accepted, the PIDP was considered as eliminated. Acceptance rate of PhI was calculated (number of PhI accepted/total number of PhI). Main outcome measure PhIs acceptance rates. Results In a cohort of 102 patients seen between July 2013 and February 2014, a total of 697 PhIs (average 6.8/patient) were made based on standard evaluation (n = 479) and STOPP/START criteria (n = 243). The global acceptance rate was 68% (standard, 78%; STOPP/START, 47%). Conclusion Good PhIs acceptance rates demonstrated that a clinical pharmacist can reduce PIDPs in a GPAU. PhIs based on standard evaluation had a higher acceptance than those based on STOPP/START criteria, probably because they are better adapted to individual patients. However, these two evaluation approaches can be used in a complementary manner.
KeywordsClinical pharmacist Potentially inappropriate drug prescribing Prescribing Psychogeriatry STOPP and START criteria Switzerland
We are thankful to Gholamrezaee Mohammad Mehdi for providing statisticical support. We are also grateful to the psychiatric, geriatric, and nursing staff of the GPAU of Lausanne University Hospital, who cooperated closely with the clinical pharmacist for this study.
This study was supported by a research award from the Swiss Association of Public Health Administration and Hospital Pharmacists (project year 2012).
Conflicts of interest
Isabella De Giorgi Salamun, Sophia Hannou, Jean-Frédéric Mall, André Pannatier, Farshid Sadeghipour, Pierre Voirol, Armin von Gunten, and Marie-Laure Weibel Borlat declare that they have no conflicts of interest.
- 6.Laroche ML, Bouthier F, Merle L, Charmes JP. Médicaments potentiellement inappropriés aux personnes agées: intérêt d’une liste adaptée à la pratique médicale française. [Potentially inappropriate medications in the elderly: a list adapted to French medical practice]. Rev Med Intern. 2009;30(7):592–601.CrossRefGoogle Scholar
- 12.American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.Google Scholar
- 17.Delgado Silveira E, Alvarez Diaz A, Perez Menendez-Conde C, Munoz Garcia M, Cruz-Jentoft A, Bermejo Vicedo T. Resultados de la integracion de la atencion farmaceutica en una Unidad de Agudos de Geriatria. [Results of integrating pharmaceutical care in an Acute Geriatric Unit]. Rev Esp Geriatr Gerontol. 2012;47(2):49–54.CrossRefPubMedGoogle Scholar
- 21.Lang PO, Hasso Y, Belmin J, Payot I, Baeyens JP, Vogt-Ferrier N, et al. STOPP-START: adaptation en langue francaise d’un outil de detection de la prescription médicamenteuse inappropriée chez la personne agée. [STOPP-START: adaptation of a French language screening tool for detecting inappropriate prescriptions in older people]. Can J Public Health. 2009;100(6):426–31.PubMedGoogle Scholar
- 26.Gillespie U, Alassaad A, Hammarlund-Udenaes M, Morlin C, Henrohn D, Bertilsson M, et al. Effects of pharmacists’ interventions on appropriateness of prescribing and evaluation of the instruments’ (MAI, STOPP and STARTs’) ability to predict hospitalization–analyses from a randomized controlled trial. PLoS ONE. 2013;8(5):e62401.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Gheewala PA, Peterson GM, Curtain CM, Nishtala PS, Hannan PJ, Castelino RL. Impact of the pharmacist medication review services on drug-related problems and potentially inappropriate prescribing of renally cleared medications in residents of aged care facilities. Drugs Aging. 2014;31(11):825–35.CrossRefPubMedGoogle Scholar
- 32.van Dijk KN, van Asselt DZ, Vogel D, van der Hooft CS, Van Roon EN, Brouwers JR. Interventies na een gestructureerde medicatie-analyse door klinisch geriater en ziekenhuisapotheker bij klinisch opgenomen kwetsbare oudere patienten. [Effects of a structured medication review by geriatrician and clinical pharmacologist on appropriateness of pharmacotherapy in frail elderly inpatients]. Tijdschr Gerontol Geriatr. 2009;40(2):72–8.PubMedGoogle Scholar
- 35.Caspari D, Wappler M, Bellaire W. Zur Behandlung des Delirium tremens–ein Vergleich zwischen Clomethiazol und Clorazepat hinsichtlich Effektivitat und Nebenwirkungsrate. [Treatment of delirium tremens–a comparison between clomethiazole and clorazepate with reference to effectiveness and rate of side effects]. Psychiatr Prax. 1992;19(1):23–7.PubMedGoogle Scholar
- 36.Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, et al. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. Am J Epidemiol. 2010;171(9):1031–6.CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Walker JG, Batterham PJ, Mackinnon AJ, Jorm AF, Hickie I, Fenech M, et al. Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms—the Beyond Ageing Project: a randomized controlled trial. Am J Clin Nutr. 2012;95(1):194–203.CrossRefPubMedGoogle Scholar