Influence of a ward-based pharmacist on the medication quality of geriatric inpatients: a before\u2013after study

Esther Katharina Kiesel,Michael Drey,Yvonne Marina Pudritz

doi:10.1007/s11096-021-01369-1

Abstract

Background Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. Method The before-after study with a historic control group was conducted on the geriatric ward. During the control phase, patients received standard care without the involvement of a pharmacist. The intervention consisted of a clinical pharmacist providing pharmaceutical care from admission to discharge. Medication quality was measured on admission and discharge using the Medication Appropriateness Index (MAI). A linear regression analysis was conducted to calculate the influence of the intervention on the MAI. Results Patients in the intervention group (n = 152, mean 83 years) were older and took more drugs at admission compared to the control group (n = 159, 81 years). For both groups, the MAI per patient improved significantly from admission to discharge. Although the intervention did not influence the summated MAI score per patient, the intervention significantly reduced the MAI criteria Dosage (p = 0.006), Correct Directions (p = 0.016) and Practical Directions (p = 0.004) as well as the proportion of overall inappropriate MAI ratings (at least 1 of 9 criteria inappropriate) (p = 0.015). Conclusion Although medication quality was already high in the control group, a ward-based clinical pharmacist could contribute meaningfully to the medication quality on an acute geriatric ward.

Highlights

Multimorbidity of geriatric patients often leads to polypharmacy and to a higher probability of interactions, side effects and other drug-related problems (DRP) [1]
It is known that pharmaceutical care delivered by clinical pharmacists with a secondary care setting can reduce drug related problems (DRP), potentially inappropriate medication (PIM) and in subgroups even readmission rates, there is only very little data available on hospital pharmacists’ effect in geriatric care in Germany [10,11,12]
The sex distribution, Charlson comorbidity score (CCS), activities of daily living (ADL), and Medication Appropriateness Index (MAI) at admission were comparable between the two groups

Summary

Introduction

Multimorbidity of geriatric patients often leads to polypharmacy and to a higher probability of interactions, side effects and other drug-related problems (DRP) [1]. It is known that pharmaceutical care delivered by clinical pharmacists with a secondary care setting can reduce drug related problems (DRP), potentially inappropriate medication (PIM) and in subgroups even readmission rates, there is only very little data available on hospital pharmacists’ effect in geriatric care in Germany [10,11,12]. All studies found were conducted without a control group [13, 14] or restricted to retrospective data analysis without pharmaceutical interventions [15, 16]. Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. A linear regression analysis was conducted to calculate the influence of the intervention on the MAI

Methods

Results

Conclusion