1: J Am Geriatr Soc. 2007 May;55(5):658-65.

Effect of a collaborative approach on the quality of prescribing for geriatric
inpatients: a randomized, controlled trial.

Spinewine A, Swine C, Dhillon S, Lambert P, Nachega JB, Wilmotte L, Tulkens PM.

Center for Clinical Pharmacy, School of Pharmacy, Université Catholique de
Louvain, Brussels, Belgium. anne.spinewine@facm.ucl.ac.be

OBJECTIVES: To evaluate the effect of pharmaceutical care provided in addition to
acute Geriatric Evaluation and Management (GEM) care on the appropriateness of
prescribing. DESIGN: Randomized, controlled trial, with the patient as unit of
randomization. SETTING: Acute GEM unit. PARTICIPANTS: Two hundred three patients
aged 70 and older. INTERVENTION: Pharmaceutical care provided from admission to
discharge by a specialist clinical pharmacist who had direct contacts with the
GEM team and patients. MEASUREMENTS: Appropriateness of prescribing on admission,
at discharge, and 3 months after discharge, using the Medication Appropriateness
Index (MAI), Beers criteria, and Assessing Care of Vulnerable Elders (ACOVE)
underuse criteria and mortality, readmission, and emergency visits up to 12
months after discharge. RESULTS: Intervention patients were significantly more
likely than control patients to have an improvement in the MAI and in the ACOVE
underuse criteria from admission to discharge (odds ratio (OR)=9.1, 95%
confidence interval (CI)=4.2-21.6 and OR=6.1, 95% CI=2.2-17.0, respectively). The
control and intervention groups had comparable improvements in the Beers
criteria. CONCLUSION: Pharmaceutical care provided in the context of acute GEM
care improved the appropriate use of medicines during the hospital stay and after
discharge. This is an important finding, because only limited data exist on the
effect of various strategies to improve medication use in elderly inpatients. The
present approach has the potential to minimize risk and improve patient outcomes.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17493184 [PubMed - indexed for MEDLINE]

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