Older people, medication usage and long-term care pharmacists: a retrospective cohort study

João Rafael Gonçalves; Betsy L Sleath; Mariana Cerdeira; Afonso Miguel Cavaco

doi:10.1136/ejhpharm-2023-003908

Older people, medication usage and long-term care pharmacists: a retrospective cohort study

Eur J Hosp Pharm. 2023 Sep 27:ejhpharm-2023-003908. doi: 10.1136/ejhpharm-2023-003908. Online ahead of print.

Authors

João Rafael Gonçalves¹, Betsy L Sleath², Mariana Cerdeira³, Afonso Miguel Cavaco⁴

Affiliations

¹ Pharmacy Practice & Health Communication Lab, iMed.ULisboa, Lisbon, Portugal joaorvg@gmail.com.
² UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.
³ Pharmacy Services, Residências Montepio - Serviços de Saúde S.A, Lisbon, Portugal.
⁴ Pharmacy Practice & Health Communication Lab, iMed.ULisboa, Lisbon, Portugal.

PMID: 37758319
DOI: 10.1136/ejhpharm-2023-003908

Abstract

Objective: To investigate the impact of the presence of a pharmacist on medication usage in long-term care facilities.

Methods: The study followed a retrospective cohort design, with a sample of patients aged ≥65 years admitted to three long-term care facilities over 30 months. Data on age, gender, type of stay, the presence or absence of a pharmacist and pharmacotherapeutic profile at admission and discharge were obtained for study patients. Variations in the number of medicines, anticholinergic burden and potentially inappropriate medications at admission and discharge were assessed as outcome variables. Anticholinergic burden and potentially inappropriate medications were assessed using the Anticholinergic Cognitive Burden scale and the EU(7)-PIM List, respectively. One-sample t-tests were used to compare the mean values of the outcome variables. A four-way ANOVA was used to test the association between background and outcome variables. Partial eta squared (η²) was used to measure the effect size.

Results: A total of 1366 patients were studied. All outcome variables showed a statistically significant increase at discharge compared with admission. The presence of a pharmacist was statistically significant in improving the number of medicines (p<0.001) and the anticholinergic burden score (p<0.001), while no statistically significant value was reached on potentially inappropriate medications (p=0.642). Small effect size values were obtained for the impact of the pharmacist on the number of medicines and anticholinergic burden scores (η²=0.021 and η²=0.011, respectively).

Conclusion: These findings suggest that the presence of a long-term care pharmacist can positively impact the use of medication associated with poor health outcomes. An integrated interprofessional approach is needed to address potentially inappropriate medications, anticholinergic burden and polypharmacy in long-term care settings, particularly at the time of discharge.

Keywords: DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; Drug Misuse; Evidence-Based Medicine; GERIATRICS; MEDICAL ERRORS; Quality of Health Care; Safety.