Multimorbidity is more common in advanced age and often leads to polypharmacy, which can be effective and sometimes even necessary, especially in patients with mental disor-ders. However, the more medications a patient takes, the greater the risk of drug interac-tions and adverse effects. Clinical pharmacists are gaining recognition for optimizing drug therapy and selecting the safest and most effective medications for patients. Studies in have shown that the involvement of clinical pharmacists is effective, especially in primary care, while data for psychiatric units are limited.
We aimed to investigate the impact of clinical pharmacists' interventions on the quality of medication prescribing by optimizing drug therapy in the elderly (clinical aspect) and on reducing the cost of pharmacotherapy (economic aspect).
We conducted a non-interventional, retrospective case study that included patients hospi-talized in the Ormož Psychiatric Unit who were referred to a clinical pharmacist for a med-ication review between the years 2013 and 2018. On the day of the consultation, patients were at least 65 years old and had prescribed at least five different medications. Using ret-rospective analysis of medical records, we collected information on the number and type of interventions made by the clinical pharmacist (primary outcomes of therapy optimization monitoring) and the financial value the suggestions adopted (secondary or economic out-comes).
The study included 106 patients (mean age 78.4 years) who had been prescribed an average of 11.4 drugs before the medication review. Medication reviews conducted by clinical pharmacists reduced the number of medications prescribed in the patients' drug regiments by an average of 1.1 and 10.3, respectively. Overall, patients received 9.6 % fewer medica-tions (from 1204 to 1089) after the medication review. The number of prescribed PIMs decreased by 53.1 % according to the Priscus list (from 96 to 45 PIM) and by 37.3 % ac-cording to the Beers criteria (from 166 to 104). A statistically significant difference was observed in reducing potential drug-drug interactions of type X from 24 to 4 (83.3 % re-duction rate) (p = 0,050), and of type D from 129 to 44, corresponding to a reduction rate of 65.9 % (p < 0,001). The number of medications prescribed without a clear indication (p < 0,001) was reduced by almost half after medication review (42.7 % reduction rate; N = 75). 177,758.5 € in unnecessary costs were saved by the considered interventions, and the ratio between invested and acquired funds for medication review was (16.0–22.6) €: 1 €. The high acceptance of the proposed interventions (63.8 %; N = 570) indicates that the collaboration between clinical pharmacists and physicians works well. The high profitability of the medication review service indicates the need for sytematic financing of the service, allowing better accessibility for patients and financial resources for hospitals employing clinical pharmacists to perform medication review services. The results of the study show that the involvement of a clinical pharmacist positively affects the quality of drug therapy in the elderly.
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