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. 2017 Mar;4(1):43-51.
doi: 10.1007/s40801-016-0098-x.

Pharmacist's Comprehensive Geriatric Assessment: Introduction and Evaluation at Elderly Patient Admission

Faiza Rhalimi  1 , Mounir Rhalimi  2   3 , Alain Rauss  4
Affiliations

Pharmacist's Comprehensive Geriatric Assessment: Introduction and Evaluation at Elderly Patient Admission

Faiza Rhalimi et al. Drugs Real World Outcomes. 2017 Mar.

Abstract

Background: The role of the clinical pharmacist within the healthcare system remains unclear.

Objective: Our objective was to describe a pharmacist's comprehensive geriatric assessment (pCGA) at admission of elderly patients and to assess its relevance in terms of medication compliance and pharmacist interventions (PIs).

Methods: We conducted a prospective interventional study over 29 months in a 34-bed medical/rehabilitation geriatric ward in a French geriatric hospital. At admission, patients received pharmaceutical care through a consistent three-step process: (1) pharmacists met with the patient to undertake cognitive screening and assess their medication adherence (using the Girerd score) and medication history; (2) medication reconciliation was conducted at admission to detect intentional and unintentional discrepancies in treatment; and (3) clinical medication review was carried out throughout the patient's stay. The pharmacist conveyed proposed interventions to optimise treatment to the physician through the electronic health record. The number and type of PIs and their rate of implementation were recorded.

Results: In total, 539 patients aged >65 years were included; their mean age was 84 years. Cognitive screening showed that 45% of patients were confused at admission. Medication adherence assessment indicated that 50.2% had adherence problems. Medication reconciliation at admission detected discrepancies in 48%, with a mean of 1.09 unintended discrepancies per patient. Patients were taking an average of 7 ± 3 drugs. In total, 828 PIs were reported to physicians; 520 were accepted and implemented (62.8% acceptance rate).

Conclusion: This approach helps to avoid medication errors and enables the suggestion of relevant PIs, which were implemented by physicians in two-thirds of cases.

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Conflict of interest statement

Funding

This study was supported by the Regional Health Agency of Picardie, a regional representation of the Ministry of Health and the Bertinot Juël hospital center.

Conflict of interest

The content of this article is the sole responsibility of the authors. Faiza Rhalimi, Mounir Rhalimi and Alain Rauss have no conflicts of interest that are directly relevant to the content of this review.

Figures

Fig. 1
Fig. 1
Flow chart, design study, pharmacist’s comprehensive geriatric assessment of the elderly patient at admission. pCGA pharmacist’s comprehensive geriatric assessment, PI pharmacist intervention, UID unintentional discrepancy
See this image and copyright information in PMC

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