Abstract
Background:Mental disorders pose a significant clinical burden and affect approximately one-third of older adults. Although studies have shown positive impacts of clinical pharmacist (CP) interventions within the general population, the long-term effects of such cooperation on geropsychiatric patients in primary care settings are not yet known. This study evaluated whether CP interventions have a long-term impact on the quality of medication prescribing in geropsychiatric patients.Methods:We conducted a retrospective non-interventional observational pre–post study for the 2015–2017 period, involving patients aged 65 or above for whom a medication review was provided by a CP. The study included participants with mental disorders treated with polypharmacy, including at least one psychotropic. Potentially inappropriate medications (PIMs) in elderly patients were determined with the Priscus list, and potential type X drug–drug interactions (pXDDIs) with Lexicomp®. Up-to-date treatment guidelines were used to evaluate patient pharmacotherapy, and patient medication was evaluated before the initial medication review and again 6 months later.Results:The study included 48 patients (79.4 years, SD = 8.13) receiving a total of 558 medications (155 for the treatment of mental disorders). The number of medications decreased by 9.5% after the medication review. The CP proposed 198 interventions related to psychotropics, of which 108 (55%) were accepted by the general practitioners. All accepted (99.1%) interventions except one were still maintained 6 months after the interventions had been proposed. They led to a significant decrease in the total number of medications, PIMs, and pXDDIs (p < 0.05), and improved treatment guidelines adherence.Conclusions:CP interventions decreased the number of medications, PIMs, and pXDDIs, and almost all interventions were maintained 6 months later. These results provide evidence for the positive effects of CP interventions in a primary care setting. Additional research with a larger sample size and a randomized study design is needed.
Highlights
Mental disorders impose a significant clinical and economic burden globally and affect about onethird of older adults
This study evaluates the long-term impact of clinical pharmacist (CP) interventions in a primary care setting on the quality of medication prescription, as measured by the number of overall medications, Potentially inappropriate medications (PIMs), and drug–drug interactions (DDIs) in geropsychiatric patients treated with polypharmacy
The participants were treated with 558 different medications, of which 155 (28%) were psychotropics and used to treat mental disorders (3.2 psychotropics per patient); 38 patients (79.2%) were treated with at least one antipsychotic and 30 patients (62.5%) with an antidepressant
Summary
Mental disorders impose a significant clinical and economic burden globally and affect about onethird of older adults. A multiple regression analysis showed an inverse association of PIMs with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude.[5] many geropsychiatric patients are treated with irrational polypharmacy: unnecessary polypharmacy used while there are alternative treatments with fewer medications that are safer and/or more effective.[6,7] Both PIMs and irrational polypharmacy can result in harm, treatment failure, and increased treatment costs.[8,9] In Slovenia, most patients with mental disorders are treated in primary care, which accounts for twothirds of antidepressants and the majority of anxiolytics prescriptions, so further research on psychotropics in primary care is needed.[10]. Conclusions: CP interventions decreased the number of medications, PIMs, and pXDDIs, and almost all interventions were maintained 6 months later These results provide evidence for the positive effects of CP interventions in a primary care setting. Additional research with a larger sample size and a randomized study design is needed
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