Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: A randomized, controlled trial

Anne Spinewine, Christian Swine, Soraya Dhillon, Philippe Lambert, Jean B. Nachega, Léon Wilmotte, Paul M. Tulkens

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)658-665
Number of pages8
JournalJournal of the American Geriatrics Society
Volume55
Issue number5
DOIs
StatePublished - May 2007
Externally publishedYes

Keywords

  • Acute geriatric care
  • Appropriateness
  • Drug therapy
  • Pharmaceutical care
  • Randomized controlled trial

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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