Evaluation of a web-based tool in screening for medication-related problems in community-dwelling older adults

Abstract

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 prospective 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 reviewed 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.