Individualized medication assessment and planning: optimizing medication use in older adults in the primary care setting. Randomized controlled trial of an intervention to improve drug appropriateness in community-dwelling polymedicated elderly people Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomised controlled trial The Senior Care Study. The optimal use of medications in acutely ill older patients. Economic outcomes of pharmacist-physician medication therapy management for polypharmacy elderly: A prospective, randomized, controlled trial. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Reduction of Potentially Inappropriate Medications Using the STOPP Criteria in Frail Older Inpatients: A Randomised Controlled Study Effectiveness of the medication safety review clinics for older adults prescribed multiple medications. Effectiveness of different medication management approaches on elders' medication adherence. Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care. Evaluation of a web-based tool in screening for medication-related problems in community-dwelling older adults. Association between unmet needs for medication support and all-cause hospitalization in community-dwelling disabled elderly people. Systematic medication review and health-related outcome in elderly patients acutely admitted to an orthopaedic ward: a randomised controlled study
STUDY OBJECTIVE To test the feasibility and effectiveness of an individualized Medication Assessment and Planning ( iMAP ) program integrated within a primary care practice on the number and prevalence of medication-related problems ( MRPs ) and acute health services utilization , defined as combined hospitalizations and emergency department visits . DESIGN Six-month , prospect i ve , observational pilot study . SETTING Community-based primary care medical practice . PATIENTS Convenience sample of 64 patients aged 65 years and older who were taking at least five medications . INTERVENTION Each patient was enrolled in the iMAP program-a collaborative , multifaceted intervention facilitated by a clinical pharmacist whereby patients receive comprehensive medication therapy management at baseline and 3 and 6 months as part of routine clinical care . MEASUREMENTS AND MAIN RESULTS MRPs were assessed and recommendations proposed using the previously published MRP classification tool ; physician acceptance of recommendations served to vali date the assessment s. There was a significant reduction in mean number of MRPs/patient ( 4.2 at baseline vs 1.0 at 6 mo , p<0.0001 ) when adjusted for number of medications , race , and pharmacist . The prevalence of MRPs at 6 months compared with baseline was also significant ( p<0.0008 ) . Acute health services utilization was assessed by medical record abstract ion . The 64 patients experienced a rate of 8.3 events/100 person-months ( 64 total events ) during the 12-month pre study period . During the 6-month study period , the same patients experienced 5.4 events/100 person-months ( 20 total events ) . Thus , we noted a reduction in acute health services utilization of 35 % . Physicians were enthusiastically supportive of iMAP . CONCLUSION iMAP has the potential to address a significant and timely issue affecting older adults and primary care practice s : the burden of managing and continuously monitoring multiple medications in medically complex older adults . A more rigorous evaluation of iMAP is warranted and planned to demonstrate sustained effectiveness and cost-benefit Background . Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems . Objectives . To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people . Design . R and omized , open-label , multicentre , parallel-arm clinical trial with 1-year follow-up . Setting . Primary care centres . Participants . Polymedicated ( ≥8 drugs ) elderly people ( ≥70 years ) . Study intervention . Pharmacist review of all medication according to the Good Palliative – Geriatric Practice algorithm and the Screening Tool of Older Person ’s Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient ’s physician . Control intervention . Routine clinical practice . Measurements . Recommendations and changes implemented , number of prescribed drugs , restarted drugs , primary care and emergency department consultations , hospitalizations and death . Results . About 503 ( 252 intervention and 251 control ) patients were recruited and 2709 drugs were evaluated . About 26.5 % of prescriptions were rated as potentially inappropriate and 21.5 % were changed ( 9.1 % discontinuation , 6.9 % dose adjustment , 3.2 % substitution and 2.2 % new prescription ) . About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6 % of patients . The mean number of prescriptions per patient was significantly lower in the intervention group at 3- and 6-month follow-up . Discontinuations , dose adjustments and substitutions were significantly higher than in the control group at 3 , 6 and 12 months . No differences were observed in the number of emergency visits , hospitalizations and deaths . Conclusion . The study intervention was safe , reduced potentially inappropriate medication , but did not reduce emergency visits and hospitalizations in polymedicated elderly people Background Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions . Objectives Our objective was to evaluate the effect of a pharmacist intervention , consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients ( RASP ) list and a pharmacist-led medication review on polypharmacy , the quality of prescribing , and clinical outcome in geriatric in patients . Methods A monocentric , prospect i ve controlled trial was undertaken at the geriatric wards of a large university hospital . Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review , upon which recommendations were provided to the treating physicians . The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission . Secondary outcomes included RASP-identified potentially inappropriate medications ( PIMs ) , the number of Emergency Department ( ED ) visits and quality of life ( QOL ) registered up to 3 months after discharge . Results On average , patients ( n = 172 ) took 10 drugs on admission and were 84.5 years ( st and ard deviation 4.8 ) of age . More drugs were discontinued or reduced in dose in the intervention group { control vs. intervention : median ( interquartile range [ IQR ] ) 3 ( 2–5 ) vs. 5 ( 3–7 ) ; p < 0.001}. More PIMs were discontinued in the intervention group , leading to less PIM at discharge [ control vs. intervention : median ( IQR ) 2 ( 1–3 ) vs. 0.5 ( 0–1 ) ; p < 0.001 ] . No signal of harm was seen , and a significant improvement of QOL and less ED visits without hospitalization were observed . Conclusions The combined intervention safely reduced drug use in very old in patients and outperformed usual geriatric care . An increased QOL was seen , as well as a trend towards less ED visits . Clinical Trials.gov Identifier : NCT01513265 Background Polypharmacy in the Swedish elderly population is currently a prioritised area of research with a focus on reducing the use of potentially inappropriate medications ( PIMs ) . Multi-professional interventions have previously been tested for their ability to improve drug therapy in frail elderly patients . Objective This study aim ed to assess a structured model for pharmacist-led medication review s in primary health care in southern Sweden and to measure its effects on numbers of patients with PIMs ( using the definition of the Swedish National Board of Health and Welfare ) using ≥10 drugs and using ≥3 psychotropics . Methods This study was a r and omised controlled clinical trial performed in a group of patients aged ≥75 years and living in nursing homes or the community and receiving municipal health care .  Medication review s were performed by trained clinical pharmacists based on nurse-initiated symptom assessment s with team-based or distance feedback to the physician . Data were collected from the patients ’ electronic medication lists and medical records at baseline and 2 months after the medication review . Results A total of 369 patients were included : 182 in the intervention group and 187 in the control group . One-third of the patients in both groups had at least one PIM at baseline . Two months after the medication review s , the number of intervention group patients with at least one PIM and the number of intervention group patients using ten or more drugs had decreased ( p = 0.007 and p = 0.001 , respectively ) , while there were no statistically significant changes in the control patients . No changes were seen in the number of patients using three or more psychotropic drugs , although the dosages of these drugs tended to decrease . Drug-related problems ( DRPs ) were identified in 93 % of the 182 patients in the intervention group . In total , there were 431 DRPs in the intervention group ( a mean of 2.5 DRPs per patient , range 0–9 , SD 1.5 at 95 % CI ) and 16 % of the DRPs were related to PIMs . Conclusions Medication review s involving pharmacists in primary health care appear to be a feasible method to reduce the number of patients with PIMs , thus improving the quality of pharmacotherapy in elderly patients Background Multimorbidity is increasing in aging population s with a corresponding increase in polypharmacy as well as inappropriate prescribing . Depending on definitions , 25 - 50 % of patients aged 75 years or older are exposed to at least five drugs . Evidence is increasing that polypharmacy , even when guidelines advise the prescribing of each drug individually , can potentially cause more harm than benefit to older patients , due to factors such as drug-drug and drug-disease interactions . Several approaches reducing polypharmacy and inappropriate prescribing have been proposed , but evidence showing a benefit of these measures regarding clinical ly relevant endpoints is scarce . There is an urgent need to implement more effective strategies . We therefore set out to develop an evidence -based electronic decision support ( eDS ) tool to aid physicians in reducing inappropriate prescribing and test its effectiveness in a large-scale cluster-r and omized controlled trial . Methods The “ Polypharmacy in chronic diseases – Reduction of Inappropriate Medication and Adverse drug events in older population s ” (PRIMA)-eDS tool is a tool comprising an indication check and recommendations for the reduction of polypharmacy and inappropriate prescribing based on systematic review s and guidelines , the European list of inappropriate medications for older people , the SFINX- data base of interactions , the PHARAO- data base on adverse effects , and the RENBASE- data base on renal dosing . The tool will be evaluated in a cluster-r and omized controlled trial involving 325 general practitioners ( GPs ) and around 3500 patients across five study centres in the United Kingdom , Germany , Austria and Italy . GP practice s will be asked to recruit 11 patients aged 75 years or older who are taking at least eight medications and will be cluster-r and omized after completion of patient recruitment . Intervention GPs will have access to the PRIMA-eDS tool , while control GPs will treat their patients according to current guidelines ( usual care ) without access to the PRIMA-eDS tool . After an observation time of 2 years , intervention and control groups will be compared regarding the primary composite endpoint of first non-elective hospitalization or death . Discussion The principal hypothesis is that reduction of polypharmacy and inappropriate prescribing can improve the clinical composite outcome of hospitalization or death . A positive result of the trial will contribute substantially to the improvement of care in multimorbidity . The trial is necessary to investigate not only whether the reduction of polypharmacy improves outcome , but also whether GPs and patients are willing to follow the recommendations of the PRIMA-eDS tool . Trial registration This trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 ( IS RCT N10137559 ) OBJECTIVE To determine whether a new model of primary care , Chronic Care Clinics , can improve outcomes of common geriatric syndromes ( urinary incontinence , falls , depressive symptoms ,  high risk medications  ,  functional impairment ) in frail older adults . DESIGN R and omized controlled trial with 24 months of follow-up . Physician practice s were r and omized either to the Chronic Care Clinics intervention or to usual care . SETTING Nine primary care physician practice s that comprise an ambulatory clinic in a large staff-model HMO in western Washington State . PARTICIPANTS Those patients aged 65 and older in each practice with the highest risk for being hospitalized or experiencing functional decline . INTERVENTION Intervention practice s ( 5 physicians , 96 patients ) held half-day Chronic Care Clinics every 3 to 4 months . These clinics included an extended visit with the physician and nurse dedicated to planning chronic disease management ; a pharmacist visit that emphasized reduction of polypharmacy and high-risk medications ; and a patient self-management/support group . Control practice s ( 4 physicians , 73 patients ) received usual care . MEASUREMENTS Changes in self-reported urinary incontinence , frequency of falls , depressive symptoms , physical function , and satisfaction were analyzed using an intention-to-treat analysis adjusted for baseline differences , covariates , and practice -level variation . Prescriptions for high-risk medications and cost/utilization data obtained from administrative data were similarly analyzed . RESULTS After 24 months , no significant improvements in frequency of incontinence , proportion with falls , depression scores , physical function scores , or prescriptions for high risk medications were demonstrated . Costs of medical care including frequency of hospitalization , hospital days , emergency and ambulatory visits , and total costs of care were not significantly different between intervention and control groups . A higher proportion of intervention patients rated the overall quality of their medical care as excellent compared with control patients ( 40.0 % vs 25.3 % , P = .10 ) . CONCLUSIONS Although intervention patients expressed high levels of satisfaction with Chronic Care Clinics , improved outcomes for selected geriatric syndromes were not demonstrated . These findings suggest the need for developing greater system-wide support for managing geriatric syndromes in primary care and illustrate the challenges of conducting practice improvement research in a rapidly changing delivery system Introduction Drug-related problems ( DRPs ) are common in the elderly , leading to suboptimal therapy , hospitalisations and increased mortality . The integrated medicines management ( IMM ) model is a multifactorial interdisciplinary methodology aim ing to optimise individual medication therapy throughout the hospital stay . IMM has been shown to reduce readmissions and drug-related hospital readmissions . Using the IMM model as a template , we have design ed an intervention aim ing both to improve medication safety in hospitals , and communication across the secondary and primary care interface . This paper presents the study protocol to explore the effects of the intervention with regard to healthcare use , health-related quality of life ( HRQoL ) and medication appropriateness in elderly patients . Methods and analysis A total of 500 patients aged ≥70 years will be included and r and omised to control ( st and ard care ) or intervention group ( 1:1 ) . The intervention comprises five steps mainly performed by pharmacists : ( 1 ) medication reconciliation at admission , ( 2 ) medication review during hospital stay , ( 3 ) patient counselling about the use of medicines , ( 4 ) a comprehensible and patient-friendly medication list with explanations in discharge summary and ( 5 ) postdischarge phone calls to the primary care level . The primary outcome is the difference between intervention and control patients in the rate of emergency medical visits ( acute readmissions and visits to emergency department ) 12 months after discharge . Secondary outcomes include length of index hospital stay , time to first readmission , mortality , hip fractures , strokes , medication changes , HRQoL and medication appropriateness . Patient inclusion started in September 2016 . Ethics and dissemination The trial was approved by the Norwegian Centre for Research Data and the Norwegian Data Protection Authority . We aim to publish the results in international peer- review ed open access journals , at national and international conferences , and as part of two PhD theses . Trial registration number NCT02816086 UNLABELLED Geriatric assessment units have improved pharmacotherapy for their patients by decreasing the number of medications prescribed . The Senior Care Study , a r and omized controlled trial , compared a multidisciplinary-team approach to patient care to the st and ard medical practice of the institution . As a part of the trial , the effectiveness of an interdisciplinary team intervention in improving the use of medications was studied . Study goals were to decrease medications used , decrease unnecessary medications , and improve medication choices in our acutely ill inpatient population . A pharmacist interviewed all experimental patients and patient records , and presented medication concerns and recommendations at a team conference . MEDICATIONs were counted on admission and on the third day , sixth week , and third month after r and omization . MEDICATIONs were paired with patient problems . MEDICATION problem pairs were judged as inappropriate choices if there were potential side effects that would affect patient function , and if better alternatives were available . The 215 control and 221 experimental patients in the study were similar in age , sex , place of origin , and number of medications on admission . Experimental patients took fewer medications than controls on the third day ( 5.3 versus 5.9 , P less than .05 ) . Experimental patients received fewer multiple unpaired medications ( 11 % versus 19 % , P less than .025 ) and fewer inappropriate medication choices ( 20 % versus 37 % , P less than .005 ) . The results suggest that the team intervention was effective in improving pharmacotherapy in the acute-care setting BACKGROUND / PURPOSE With an increasing geriatric population , the need for effective management of chronic conditions and medication use in the elderly is growing . Medication use in the elderly presents significant challenges due to changes in pharmacodynamic and pharmacokinetic profiles . We aim ed to examine the impact of a collaborative physician-pharmacist medication therapy management ( MTM ) program for polypharmacy elderly patients . METHODS Elderly patients with multiple chronic conditions on polypharmacy were enrolled in this prospect i ve , r and omized , and controlled study over 16 months of implementation . The intervention group consisted of patients r and omized to a collaborative pharmacist-physician MTM program .  They were monitored continuously by a clinical pharmacist , while patients in the control group received only usual care with follow-up assessment . Primary outcome was economic differences , measured in total medical expenditure . Secondary outcomes of clinical and humanistic effects were compared between the two groups . RESULTS The total number of enrolled patients was 87 and 91 in the MTM and usual groups , respectively . The difference-in-difference estimate on medical expenditure during the 16-month implementation period was $ 3,758,373 New Taiwan Dollars ( $ 127,015 US Dollars ) less than the usually care group . Impact was also seen in humanistic outcomes while lipid profiles and mortality trended toward improvement . CONCLUSION The pharmacist-physician collaborative MTM program for polypharmacy elderly had significant cost savings and improvement in humanistic measures , demonstrating the importance of clinical pharmacists and MTM programs for elderly patients in Taiwan . The results suggest the possibility of clinical benefits , but the study was not substantially powered to find a statistical difference PURPOSE To evaluate the effect of sustained clinical pharmacist interventions involving elderly out patients with polypharmacy and their primary physicians . PATIENTS AND METHODS R and omized , controlled trial of 208 patients aged 65 years or older with polypharmacy ( > or = 5 chronic medications ) from a general medicine clinic of a Veterans Affairs Medical Center . A clinical pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians . Outcome measures were prescribing appropriateness , health-related quality of life , adverse drug events , medication compliance and knowledge , number of medications , patient satisfaction , and physician receptivity . RESULTS Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months ( decrease 24 % versus 6 % , respectively ; P = 0.0006 ) and was sustained at 12 months ( decrease 28 % versus 5 % , respectively ; P = 0.0002 ) . There was no difference between groups at closeout in health-related quality of life ( P = 0.99 ) . Fewer intervention than control patients ( 30.2 % ) versus 40.0 % ; P = 0.19 ) experienced adverse drug events . Measures for most other outcomes remained unchanged in both groups . Physicians were receptive to the intervention and enacted changes recommended by the clinical pharmacist more frequently than they enacted changes independently for control patients ( 55.1 % versus 19.8 % ; P < 0.001 ) . CONCLUSIONS This study demonstrates that a clinical pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life Background Hospital admissions may provide an opportunity to discontinue potentially inappropriate medications ( PIMs ) in older patients . Little is known about the effect of using the Screening Tool of Older People ’s potentially inappropriate Prescriptions ( STOPP ) in this context . This study aim ed to test the hypothesis that specific STOPP recommendations from an inpatient geriatric consultation team ( IGCT ) to the hospital physician leads to reductions in PIMs for patients at discharge . Methods This was a r and omised controlled study in 146 frail in patients ( in 2011 ) . The intervention consisted of STOPP recommendations made by the IGCT to ward physicians to discontinue PIMs , in addition to the st and ard geriatric advice . Results Intervention ( n = 74 ) and control ( n = 72 ) groups were similar in terms of patient characteristics ( median age 85 years ; median number of daily drugs , seven ) and PIM distribution ( 68 and 57 PIMs in 53 and 51 % of patients , respectively ) . At discharge , the reduction in PIMs was twice as high for the intervention group as for the control group ( 39.7 and 19.3 % , respectively ; p = 0.013 ) . The proportion of patients who still had one or more PIM at discharge did not differ between groups . In the 50 patients followed-up a year later , the majority of PIMs that had been stopped during hospitalisation had not been restarted after discharge ( 17/28 ; 61 % ) . The clinical relevance of PIMs identified at baseline in those patients was considered major ( 29 % ) , moderate ( 37 % ) , minor ( 5 % ) , deleterious ( 8 % ) , or not assessed ( 11 % ) . Discontinuation rate was not associated with clinical importance . ConclusionS pecific STOPP recommendations provided to hospital physicians doubled the reduction of PIMs at discharge in frail older in patients . To further improve the appropriateness of prescribing in older patients , clinicians should focus on the STOPP criteria that are of major clinical importance , and general practitioners should be actively involved BACKGROUND / PURPOSE Polypharmacy is common among Taiwanese older adults . We aim to determine the effectiveness of the medication safety review clinics ( MSRCs ) for solving drug-related problems ( DRPs ) among older adults prescribed multiple medications . METHODS This prospect i ve case-series intervention study was conducted at the outpatient department of the National Taiwan University Hospital and its BeiHu Branch . Older adults ( ≥65 years ) who either had been prescribed ≥8 chronic medications ( drugs prescribed for ≥28 days ) or had visited ≥3 different physicians during the 3-month screening period were enrolled ( N = 193 ) . DRPs were identified after baseline assessment s from a team of geriatricians and pharmacists . Prescribers were contacted with proposed interventions to be administered within 12 weeks . Problem-solving rates ( PSRs ) at both Week 12 and Week 24 visits were recorded . Stepwise multivariate logistic regression was applied to identify correlates of having at least one unsolved DRP at 24 weeks . Participants ( N = 139 ) who completed four visits to the MSRCs were analyzed . RESULTS The mean age was 75.6 ± 6.1 years and 56 % of them were men . The mean chronic medication per patient was 9.0 ± 3.1 , and the mean DRP per patient was 2.1 ± 1.5 . The PSR was 76 % at Week 12 and 87 % at Week 24 . Thirty-two patients ( 22 % ) had at least one unsolved DRP . Correlates of the unsolved DRP included a higher geriatric depression scale , a higher chronic medication per patient , and a higher DRP per patient . The mean chronic medication per patient ( 9.0 vs. 8.6 , p < 0.05 ) decreased , and the number of participants rating good or better health status improved from 22 % to 38 % in 24 weeks ( p < 0.001 ) . Participants were highly satisfied ( 96 % at all times ) with the service . CONCLUSION DRPs were common in geriatric out patients taking multiple medications and most were solved with appropriate interventions . The MSRC service may improve prescription quality in Taiwan if widely available This pilot study investigated the effects of three different medication management approaches on medication adherence and re source utilization .  Sixty-one participants living in an independent elder community in South Florida were r and omly assigned to one of the three medication management approaches : ( 1 ) a pillbox method , ( 2 ) a voice-activated method , and ( 3 ) self-administration of medications as they had in the past . One outcome was measured by recording the number of doses of medications ingested over a 1- , 3- , and 6-month period . Adherence to medications also was measured by the impact on the medical diagnosis . For example , the hypertensive group was defined adherent by a sustained normotensive pressure . Participants ' medical records were examined as to the number of physician office visits , hospitalizations , and home health visits . There were significant differences in the mean number of doses missed , with the fewest in the voice-activated group to the highest in the self-administration ( control ) group . Additionally , the group that self-administered their own medications had more frequent physician office visits and increased hospitalizations . Because the elder population is prone to medication mismanagement for a variety of reasons , nurses are in a unique position to identify population s at risk and suggest interventions that may improve medication adherence BACKGROUND Effective new strategies that complement primary care are needed to reduce disability risks and improve self-management of chronic illness in frail older people living in the community . OBJECTIVE To evaluate the impact of a 1-year , senior center-based chronic illness self-management and disability prevention program on health , functioning , and healthcare utilization in frail older adults . DESIGN A r and omized controlled trial . SETTING A large senior center located in a northeast Seattle suburb . The trial was conducted in collaboration with primary care providers of two large managed care organizations . PARTICIPANTS A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practice s. INTERVENTION A targeted , multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner ( GNP ) . MEASUREMENTS Self-reported Physical function , physical performance tests , health care utilization , and health behaviors . RESULTS Each of 101 intervention participants met with the GNP from 1 to 8 times ( median = 3 ) during the study year . The intervention group showed less decline in function , as measured by disability days and lower scores on the Health Assessment Question naire . Other measures of function , including the SF-36 and a battery of physical performance tests , did not change with the intervention . The number of hospitalized participants increased by 69 % among the controls and decreased by 38 % in the intervention group ( P = .083 ) . The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls ( total days = 33 vs 116 , P = .049 ) . The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications . CONCLUSIONS This project provides evidence that a community-based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults . Linking organized medical care with complementary community-based interventions may be a promising direction for research and practice OBJECTIVE The primary objective was to evaluate the effectiveness of a Web-based program , Monitor-Rx , in identifying older adults at risk for drug-related geriatric syndromes or inappropriate medicines . DESIGN This prospect i ve pilot study compared medication related risks generated by the Web-based program with those identified by a certified geriatric pharmacist ( CGP ) . SETTING Wisconsin-based community pharmacy serving primarily older adults . PARTICIPANTS 29 community-dwelling older adults ( mean age : 81.6 years , mean daily medications : 11.7 ) . INTERVENTIONS Each participant received a complete medication history , including self-identified geriatric syndromes . Each participant 's demographic information and medications were entered into Monitor-Rx and concurrently review ed by a CGP . MAIN OUTCOME MEASURES Number of potentially inappropriate medications ( PIMs ) , anticholinergic medicines , and identified geriatric syndromes . RESULTS All participants were identified as at risk for falls by Monitor-Rx and the CGP . Significant medication-related risks identified were urinary incontinence , cognition/memory , nutrition , and dental care . Monitor-Rx identified more participants at risk for geriatric syndromes than the CGP ; however , PIMs were identified more frequently by the CGP . Twenty-six participants self-identified at least one geriatric syndrome . Prevalence of anticholinergic use was more than 75 % . CONCLUSIONS In the participants screened , Monitor-Rx was successful at identifying those with a high risk of drug-related geriatric syndromes . An interview was also important to clarify use of the PIM and to identify whether at-risk participants were actually experiencing the drug related geriatric syndromes . Use of the Web-based tool does not supplant the experience of a well-trained geriatric pharmacist and the professional judgment that comes with that experience OBJECTIVES To clarify the association between unmet medication management need and 3-year mortality and hospitalization for community-dwelling older people with various levels of disabilities . DESIGN Prospect i ve cohort study ( the Nagoya Longitudinal Study for Frail Elderly ) . SETTING Community-based . PARTICIPANTS One thous and seven hundred seventy-two community-dwelling elderly subjects ( 611 men , 1,161 women ) . MEASUREMENTS Data included the clients ' demographic characteristics , a rating for basic and instrumental activities of daily living ( ADLs ) , number of prescribed medications and physician-diagnosed chronic diseases , medication adherence , ability to manage medication  , and  presence or absence of medication assistance .  Cox proportional hazard models and the Kaplan-Meier method were used to assess the association between the medication management at baseline and mortality or hospitalization during a 3-year period . RESULTS Of 1,772 participants , 681 reported no difficulty with self-medication management , and 1,091 experienced difficulty with self-medication . Of participants with difficulty with self-medication management , 929 had  medication assistance  , and 162 did not . During a 3-year follow up , 424 participants died , and 758 were admitted to hospitals . The baseline data demonstrated that participants not receiving medication assistance were younger and had better ADL status and fewer comorbidities . Multivariate Cox regression models adjusting for potential confounders showed that the lack of assistance in those who needed medication assistance was associated with hospitalization but not mortality during the study period . CONCLUSION In community-dwelling disabled elderly people , lack of medication assistance in those needing medication support was associated with higher risk of hospitalization Background Acute admission to hospitals , age and number of drugs are associated with an increased risk of adverse drug events due to morbidity , poly-pharmacy and inappropriate interactions . Thus , the objective of the present study was to investigate if systematic medication review and drug counseling on admission to hospitals would have a significant impact at clinical ly health-related outcomes in elderly patients admitted acutely to an orthopaedic ward . Methods A r and omised controlled study comprising 108 patients aged 65 years or older admitted acutely to an orthopaedic ward in Denmark was conducted . Intervention : a clinical pharmacist collected information regarding the patient ’s medication and medical history in the medical record , the electronic drug order system , the registry of drug purchase and interview with the patient ’s . Subsequently , this was discussed with a clinical pharmacologist and an advisory note with drug recommendations were h and ed directly to the ward physicians . Control : the usual medication routine in the ward . The primary outcome measure was time to first unscheduled contact to a physician post-discharge limited to emergency department visit , readmission and general practitioner . Secondary outcomes were admission time , time to first re-admission , number of re-admissions , emergency department visits , ambulatory care visits , contact to general practitioner , physicians outside working hours , medical specialist and finally , quality of life at three-month follow up . Results In the intervention group time to first unscheduled contact to a physician post-discharge was 16.3 days(95%CI : 10.522.2 ) and in the control group 25.6 days ( 95%CI:17.8 - 33.4 ) , which was not a statistically significant difference . No overall differences between study groups were seen in the secondary outcome measures . The physicians complied with 41 of 222 drug recommendations . Subgroup analysis indicated that physicians were more prone to accept recommendations in the very old treated with numerous of drugs . Conclusion The findings do not lead to the recommendation of an extra medication review in a general population of elderly admitted acutely to an orthopaedic ward . Considering the physicians marked hesitation to comply with drug recommendations future studies should explore the impact of a differentiated medication review in acute admitted patients based on the individual patient ’s risk of adverse drug events
This review will provide an exhaustive view of medication management models that could be effective for polymedicated , home-dwelling older adults and will allow us to analyze their impact on managing and preventing MRPs .
BACKGROUND Older adults with multiple chronic diseases commonly require complex medication regimes .
When combined with frailty , cognitive impairment , and changing pharmacological prescriptions , older adults ' polymedication regimes increase the risk of medication-related problems ( MRPs ) and hospitalization .
Effective , well-organized medication management could avoid MRPs and their clinical outcomes .
OBJECTIVE Identify medication management models and analyze their impact on managing and preventing MRPs for polymedicated , home-dwelling older adults .