Outcomes of a pharmacist-led medication review programme for hospitalised elderly patients.

INTRODUCTION Elderly patients are at risk of drug-related problems. This study aimed to determine whether a pharmacist-led medication review programme could reduce inappropriate medications and hospital readmissions among geriatric in-patients in Hong Kong. METHODS This prospective controlled study was conducted in a geriatric unit of a regional hospital in Hong Kong. The study period was from December 2013 to September 2014. Two hundred and twelve patients were allocated to receive either routine care (104) or pharmacist intervention (108) that included medication reconciliation, medication review, and medication counselling. Medication appropriateness was assessed by a pharmacist using the Medication Appropriateness Index. Recommendations made by the pharmacist were communicated to physicians. RESULTS At hospital admission, 51.9% of intervention and 58.7% of control patients had at least one inappropriate medication (P=0.319). Unintended discrepancy applied in 19.4% of intervention patients of which 90.7% were due to omissions. Following pharmacist recommendations, 60 of 93 medication reviews and 32 of 41 medication reconciliations (68.7%) were accepted by physicians and implemented. After the program and at discharge, the proportion of subjects with inappropriate medications in the intervention group was significantly lower than that in the control group (28.0% vs 56.4%; P<0.001). The unplanned hospital readmission rate 1 month after discharge was significantly lower in the intervention group than that in the control group (13.2% vs 29.1%; P=0.005). Overall, 98.0% of intervention subjects were satisfied with the programme. There were no differences in the length of hospital stay, number of emergency department visits, or mortality rate between the intervention and control groups. CONCLUSIONS A pharmacist-led medication review programme that was supported by geriatricians significantly reduced the number of inappropriate medications and unplanned hospital readmissions among geriatric in-patients.