Effect of a Collaborative Approach on the Quality of Prescribing for Geriatric Inpatients: A Randomized, Controlled Trial

Authors

  • Anne Spinewine PhD,

    1. From the *Center for Clinical Pharmacy, School of Pharmacy, Cliniques Universitaires Saint-Luc, and Department of Cellular and Molecular Pharmacology, Université catholique de Louvain, Brussels, Belgium§Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, BelgiumSchool of Pharmacy, University of Hertfordshire, Herts, United KingdomInstitute for Human and Social Sciences, Université de Liège, Liège, Belgium#Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and **Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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  • Christian Swine MD,

    1. From the *Center for Clinical Pharmacy, School of Pharmacy, Cliniques Universitaires Saint-Luc, and Department of Cellular and Molecular Pharmacology, Université catholique de Louvain, Brussels, Belgium§Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, BelgiumSchool of Pharmacy, University of Hertfordshire, Herts, United KingdomInstitute for Human and Social Sciences, Université de Liège, Liège, Belgium#Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and **Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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  • Soraya Dhillon PhD,

    1. From the *Center for Clinical Pharmacy, School of Pharmacy, Cliniques Universitaires Saint-Luc, and Department of Cellular and Molecular Pharmacology, Université catholique de Louvain, Brussels, Belgium§Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, BelgiumSchool of Pharmacy, University of Hertfordshire, Herts, United KingdomInstitute for Human and Social Sciences, Université de Liège, Liège, Belgium#Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and **Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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  • Philippe Lambert PhD,

    1. From the *Center for Clinical Pharmacy, School of Pharmacy, Cliniques Universitaires Saint-Luc, and Department of Cellular and Molecular Pharmacology, Université catholique de Louvain, Brussels, Belgium§Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, BelgiumSchool of Pharmacy, University of Hertfordshire, Herts, United KingdomInstitute for Human and Social Sciences, Université de Liège, Liège, Belgium#Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and **Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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  • Jean B. Nachega MD, MPH, DTM&H,

    1. From the *Center for Clinical Pharmacy, School of Pharmacy, Cliniques Universitaires Saint-Luc, and Department of Cellular and Molecular Pharmacology, Université catholique de Louvain, Brussels, Belgium§Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, BelgiumSchool of Pharmacy, University of Hertfordshire, Herts, United KingdomInstitute for Human and Social Sciences, Université de Liège, Liège, Belgium#Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and **Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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  • Léon Wilmotte MPharm,

    1. From the *Center for Clinical Pharmacy, School of Pharmacy, Cliniques Universitaires Saint-Luc, and Department of Cellular and Molecular Pharmacology, Université catholique de Louvain, Brussels, Belgium§Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, BelgiumSchool of Pharmacy, University of Hertfordshire, Herts, United KingdomInstitute for Human and Social Sciences, Université de Liège, Liège, Belgium#Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and **Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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  • Paul M. Tulkens MD, PhD

    1. From the *Center for Clinical Pharmacy, School of Pharmacy, Cliniques Universitaires Saint-Luc, and Department of Cellular and Molecular Pharmacology, Université catholique de Louvain, Brussels, Belgium§Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, BelgiumSchool of Pharmacy, University of Hertfordshire, Herts, United KingdomInstitute for Human and Social Sciences, Université de Liège, Liège, Belgium#Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and **Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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  • Part of this work was presented as a poster (#D101) during the annual meeting of the American Geriatrics Society, Orlando, Florida, May 13–14, 2005.

Address correspondence to Anne Spinewine, Center for Clinical Pharmacy, Université catholique de Louvain, UCL 73.70 Avenue E. Mounier, 73, 1200 Bruxelles, Belgium. E-mail: anne.spinewine@facm.ucl.ac.be

Abstract

OBJECTIVES: To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management (GEM) care on the appropriateness of prescribing.

DESIGN: Randomized, controlled trial, with the patient as unit of randomization.

SETTING: Acute GEM unit.

PARTICIPANTS: Two hundred three patients aged 70 and older.

INTERVENTION: Pharmaceutical care provided from admission to discharge by a specialist clinical pharmacist who had direct contacts with the GEM team and patients.

MEASUREMENTS: Appropriateness of prescribing on admission, at discharge, and 3 months after discharge, using the Medication Appropriateness Index (MAI), Beers criteria, and Assessing Care of Vulnerable Elders (ACOVE) underuse criteria and mortality, readmission, and emergency visits up to 12 months after discharge.

RESULTS: Intervention patients were significantly more likely than control patients to have an improvement in the MAI and in the ACOVE underuse criteria from admission to discharge (odds ratio (OR)=9.1, 95% confidence interval (CI)=4.2–21.6 and OR=6.1, 95% CI=2.2–17.0, respectively). The control and intervention groups had comparable improvements in the Beers criteria.

CONCLUSION: Pharmaceutical care provided in the context of acute GEM care improved the appropriate use of medicines during the hospital stay and after discharge. This is an important finding, because only limited data exist on the effect of various strategies to improve medication use in elderly inpatients. The present approach has the potential to minimize risk and improve patient outcomes.

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