Abstract
Aim of the studyThis prospective, controlled trial aimed to assess the effect of pharmacist-led medication reviews on the medication safety of psychiatric inpatients by the resolution of Drug-Related Problems (DRP). Both the therapy appropriateness measured with the Medication Appropriateness Index (MAI) and the number of unsolved DRP per patient were chosen as primary outcome measures.MethodsDepending on their time of admission, 269 psychiatric patients that were admitted to a psychiatric university hospital were allocated in control (09/2012-03/2013) or intervention group (05/2013-12/2013). In both groups, DRP were identified by comprehensive medication reviews by clinical pharmacists at admission, during the hospital stay, and at discharge. In the intervention group, recommendations for identified DRP were compiled by the pharmacists and discussed with the therapeutic team. In the control group, recommendations were not provided except for serious or life threatening DRP. As a primary outcome measure, the changes in therapy appropriateness from admission to discharge as well as from admission to three months after discharge (follow-up) assessed with the MAI were compared between both groups. The second primary outcome was the number of unsolved DRP per patient after completing the study protocol. The DRP type, the relevance and the potential of drugs to cause DRP were also evaluated.ResultsThe intervention led to a reduced MAI score by 1.4 points per patient (95% confidence interval [CI]: 0.8–2.0) at discharge and 1.3 points (95% CI: 0.7–1.9) at follow-up compared with controls. The number of unsolved DRP in the intervention group was 1.8 (95% CI: 1.5–2.1) less than in control.ConclusionThe pharmaceutical medication reviews with interdisciplinary discussion of identified DRP appears to be a worthy strategy to improve medication safety in psychiatry as reflected by less unsolved DRP per patient and an enhanced appropriateness of therapy. The promising results of this trial likely warrant further research that evaluates direct clinical outcomes and health-related costs.Trial RegistrationDeutsches Register Klinischer Studien (DRKS), DRKS00006358
Highlights
The intervention led to a reduced Medication Appropriateness Index (MAI) score by 1.4 points per patient (95% confidence interval [CI]: 0.8–2.0) at discharge and 1.3 points at follow-up compared with
The number of unsolved Drug-Related Problems (DRP) in the intervention group was 1.8 less than in control
As a result of the high prevalence of risk factors, such as polypharmacy commonly applied by multiple prescribers, several comorbidities and inadequate adherence, psychiatric patients are at significant risk for Drug-Related Problems (DRP) [1]
Summary
As a result of the high prevalence of risk factors, such as polypharmacy commonly applied by multiple prescribers, several comorbidities and inadequate adherence, psychiatric patients are at significant risk for Drug-Related Problems (DRP) [1]. DRP comprise both non-preventable Adverse Drug Events (ADE) and errors in medication therapy that differ in their actual or potential risks to cause patient harm [2]. There is evidence for an increased prevalence of ADE and medication errors in the psychiatric setting compared with other medical conditions [4,5,6], which substantially endanger the medication safety of psychiatric patients [7]. An increased awareness regarding the safety of drug therapy emerged in the psychiatric setting with a Task Force on Patient Safety published by the American Psychiatric Association (APA) [7]. The implementation of strategies to identify, report and prevent medication errors was recommended as one of the most important activities to improve the safety of psychiatric patients
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