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. 2020 Jul 17:13:39.
doi: 10.1186/s40545-020-00236-0. eCollection 2020.

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

Muhammad Eid Akkawi  1 , Mohamad Haniki Nik Mohamed  1 , Mohd Aznan Md Aris  2
Affiliations

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

Muhammad Eid Akkawi et al. J Pharm Policy Pract. .

Abstract

Background: Potentially inappropriate prescribing (PIP) is associated with the incidence of adverse drug reactions, drug-related hospitalization and other negative outcomes in older adults. After hospitalization, older adults might be discharged with several types of PIPs. Studies have found that the lack of healthcare professionals' (HCPs) knowledge regarding PIP is one of the major contributing factors in this issue. The purpose of this study is to investigate the impact of a multifaceted intervention on physicians' and clinical pharmacists' behavior regarding potentially inappropriate medication (PIM) and potential prescribing omission (PPO) among hospitalized older adults.

Methods: This is a before-and-after study that took place in a tertiary Malaysian hospital. Discharge medications of patients ≥65 years old were reviewed to identify PIMs/PPOs using version 2 of the STOPP/START criteria. The prevalence and pattern of PIM/PPO before and after the intervention were compared. The intervention targeted the physicians and clinical pharmacists and it consisted of academic detailing and a newly developed smartphone application (app).

Results: The study involved 240 patients before (control group) and 240 patients after the intervention. The prevalence of PIM was 22% and 27% before and after the intervention, respectively (P = 0.213). The prevalence of PPO in the intervention group was significantly lower than that in the control group (42% Vs. 53.3%); P = 0.014. This difference remained statistically significant after controlling for other variables (P = 0.015). The intervention was effective in reducing the two most common PPOs; the omission of vitamin D supplements in patients with a history of falls (P = 0.001) and the omission of angiotensin converting enzyme inhibitor in patients with coronary artery disease (P = 0.03).

Conclusions: The smartphone app coupled with academic detailing was effective in reducing the prevalence of PPO at discharge. However, it did not significantly affect the prevalence or pattern of PIM.

Keywords: Academic detailing; Older adults; Potential prescribing omission; Potentially inappropriate medication; Smartphone app.

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Conflict of interest statement

Competing interestsThe authors disclose no conflict of interest.

Figures

Fig. 1
Fig. 1
The behavior change wheel. Used with a permission from [28]
Fig. 2
Fig. 2
Screenshot shows searching for captopril-related recommendations on Plus65 Med©
Fig. 3
Fig. 3
Distribution of PIMs among the two groups
Fig. 4
Fig. 4
Distribution of PPOs among the study group
See this image and copyright information in PMC

References

    1. MN OC, Gallagher P, O’Mahony D. Inappropriate Prescribing: Criteria. Detect Prevent Drugs Aging. 2012;29(6):437–452. - PubMed
    1. Samuel MJ. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–2246. doi: 10.1111/jgs.13702. - DOI - PubMed
    1. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing [Internet] 2015;44(2):213–218. doi: 10.1093/ageing/afu145. - DOI - PMC - PubMed
    1. Weir DL, Lee TC, McDonald EG, Motulsky A, Abrahamowicz M, Morgan S, et al.. Both New and Chronic Potentially Inappropriate Medications Continued at Hospital Discharge Are Associated With Increased Risk of Adverse Events. J Am Geriatr Soc. 2020;00(00). Available from: http://doi.wiley.com/10.1111/jgs.16413 [cited 2020 18 May]. - DOI - PMC - PubMed
    1. Komagamine J, Yabuki T, Kobayashi M. Association between potentially inappropriate medications at discharge and unplanned readmissions among hospitalised elderly patients at a single Centre in Japan: a prospective observational study. BMJ Open. 2019;9(11):1–8. doi: 10.1136/bmjopen-2019-032574. - DOI - PMC - PubMed