Abstract
As a pharmacy service giving pharmaceutical care at different levels of health care for elderly people, we needed a standardization procedure for recording and evaluating pharmacists’ interventions. Our objective was to homogenize pharmacist interventions; to know physicians’ acceptance of our recommendations, as well as the most prevalent drug related problems (DRP); and the impact of the pharmacists’ interventions. To achieve this goal we conducted a one year prospective study at two levels of health care: 176 nursing homes (EAR) (8828 patients) and 2 long-term and subacute care hospitals (HSS) (268 beds). Pharmacists’ interventions were recorded using the American Society of Health-System Pharmacists classification as the basis. Frequency of the different DRP and the level of response and acceptance on the part of physicians was determined. The Medication Appropriateness Index (MAI) was used to evaluate the impact of the interventions on the prescription quality. Patients’ mean age was 84.2 (EAR) and 80.7 (HSS), and in both cases, polypharmacy ≥ 9 drugs was around 63–69%. There were 4073 interventions done in EAR and 2560 in HSS. Level of response: 44% (EAR), 79% (HSS); degree of acceptance of the recommendations: 84% (EAR), 72% (HSS). Most frequent DRP: inappropriate dose, length of therapy, omissions, and financial impact. Drugs for the nervous system are those with the most DRP. MAI values/medication improved from 4.4 to 2.7 (EAR) and 3.8 to 1.7 (HSS). A normalized way of managing pharmacists’ interventions for different health care levels has been established. We are on the way to increasing collaborative work with physicians and we know which DRPs are most prevalent.
Highlights
Pharmacists have been progressively included in healthcare teams delivering integrated care.The development of pharmaceutical care [1] has permitted pharmacists to provide direct medication-related care with the aim of improving patients’ quality of life
We report the process of homogenization of pharmacist interventions done by our pharmacy department, as well as an evaluation of this intervention depending on the type of level of care (HSS or EAR) and the impact on improvements in drug treatment
The project was undertaken at two different levels of health care managed by our institution: two long-term care and subacute care hospitals (HSS): HSS Mutuam Güell (Barcelona, Spain) (165 beds) and HSS Mutuam Girona (103 beds) and 9 teams (EARs) teams composed of a physician and 2 to 3 nurses giving healthcare support to 176 nursing homes (8828 patients) in the city of Barcelona
Summary
Pharmacists have been progressively included in healthcare teams delivering integrated care. The development of pharmaceutical care [1] has permitted pharmacists to provide direct medication-related care with the aim of improving patients’ quality of life. Even though there have been great advances, they have been accomplished mostly in acute care institutions such as hospitals. These institutions have a larger staff of pharmacists that have been integrated into healthcare teams for a longer time. In other kinds of institutions, like ours, devoted to geriatric patients (long-term care, subacute care, nursing homes), there has been some improvement only recently [2].
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