Pharmacist involvement to decrease drug-related problems among geriatric patients in indonesian primary health centers

Abstract

Objective: The studies have demonstrated that older people often suffer from multiple diseases and are thus prescribed many different drugs. Therefore, drug-related problems (DRPs) are common in the elderly. The main objectives of this study were to reduce the number of DRPs in the elderly through pharmacist involvement and to analyze differences after pharmacist recommendations. Methods: In a quasi-experimental study, 12 primary health centers were selected and randomly divided into two groups (six in each group). In the first group, the physicians received pharmacist recommendations verbally through discussions, and in the second group, the physicians received recommendations through letters. DRPs were analyzed from all older inpatients’ medical records 1 month before and 1 month after the pharmacist recommendations. The main outcome being measured was the incidence of DRPs, classified into problems, and causes according to the Indonesian translated version of Pharmaceutical Care Network Europe, Version 6.2 (PCNE V 6.2). The problems were identified based on journal articles and other relevant literature. Results: A total of 205 patients were analyzed before pharmacist intervention (Group 1: 121; Group 2: 84) and 202 patients after the intervention (Group 1: 108; Group 2: 94). The most common problem in these elderly patients was that they suffered from toxic effects. The most common cause was inappropriate drug selection. The number of DRPs and causes were decreased significantly through the discussions (Wilcoxon signed-rank test, problems p=0.027, causes p=0.028). DRPs were also significantly decreased through the recommendation letters (paired t-test, number of problems p=0.003, and causes p=0.004). Discussion with physicians seemed more effective and decreased more problems (p=0.001) and causes (p=0.002). Through discussions, the decrease in a number of problems was 20.83±8.931, and the decrease in the number of causes was 25.33±11.431 versus the recommendation letter, at 4.17±1.941 and 5.17±2.483, respectively. Conclusion: Pharmacist involvement decreased DRPs among older inpatients. Discussing DRPs with the physicians treating the patients is more effective than giving recommendations in writing only. The PCNE V 6.2 DRP classification system is useful for documenting DRPs among the elderly as it can help pharmacists develop plans to reduce DRPs.