Drug-related problems and pharmacist interventions in long-term care

Abstract

Background: Drug-related problems (DRPs) are common in longterm care facilities for older persons suffering from polypharmacy and multimorbidities. Identification and resolution of DRPs is effectively carried out through clinical pharmacist intervention. Aim: To explore DRPs in long-term care institutions for older persons, to detect the causes of the DRPs, and discover clinical pharmacist interventions and their acceptance among prescribers. The interventions promote better medication management and active ageing. Method: Four wards in a long-term care institution were chosen by convenience sampling. Patients over 65 years of age and being cognitively intact were included in the study. A clinical pharmacist attended the wards 2–3 times weekly for 8 weeks, carrying out medication reconciliation, medicines use review, monitoring, checking interactions and dose adjustments. DRPs were classified according to the Pharmaceutical Care Network Europe Classification for Drug-Related Problems V9.1. Clinical pharmacist interventions for each DRP to the prescribing team and to the patient were recorded. The level of acceptance from the prescribers and the outcome of the DRP were noted. Results: Forty patients were included in the study, 24 males and 16 females, with a mean age of 82.83 years. The average number of chronic medications per patient was 12.85. Almost half of the patients (n = 17,42.5%) were found to have four or more DRPs. DRPs identified amounted to 126. The ‘treatment effectiveness’ group exhibited the highest frequency for DRPs (59.52%). Drug selection was deemed the highest cause for DRPs (n = 48,33.57%), followed by dose selection (n = 43, 30.07%). The interventions carried out amounted to 254. From interventions at drug level, dosage changed was the highest frequency recorded (n = 35). Fifty percent of interventions were carried out prescriber level while 9.06% of interventions were aimed at the patient. Interventions accepted and fully implemented amounted to 63.49% and the interventions accepted over the three prescribers was 83.3%. DRPs were totally solved at 71.43%. Over the course of the study, 43 medications or supplements were deprescribed, the most common medication totally or partially deprescribed being omeprazole (n = 39). Conclusion: The geriatric clinical pharmacist plays a role in longterm care, identifying DRPs and mitigating them as early as possible. The significance of carrying out such roles as medicines use review and monitoring frequently, is that optimal efficacy of medications is ensured. Prescribers appreciated the clinical pharmacist’s input, the interventions aiding in their time-constrained schedule to give more attention to detail, ensuring accuracy in treatment and deprescribing where appropriate.