Assessment of clinical pharmacy interventions to reduce outpatient use of high-risk medications in the elderly

Sarah C. Weddle, Anthony Rowe, Julie Jeter, Rachel C. Renwick, Shaunta' Chamberlin, Andrea Franks

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Use of high-risk medications in the elderly (HRME) and drug-disease (Rx-DIS) interactions in the elderly, as defined by the Healthcare Effectiveness Data and Information Set (HEDIS) Measures, are significantly associated with mortality, hospital admission, and need for emergency care. No published studies to date evaluate interventions to reduce the use of HEDIS-defined HRME, although many studies have postulated a beneficial effect of such interventions. OBJECTIVE: To evaluate the effect of pharmacist interventions on use of HRME and Rx-DIS interactions in the outpatient elderly population. METHODS: This retrospective cohort study was conducted in a residentbased family medicine clinic. Patients aged = 65 years were prospectively screened for the use of HRME and Rx-DIS interactions before their visits with their primary care providers. If HRME or Rx-DIS interactions were noted, the clinical pharmacist sent messages to the physicians through the electronic medical record, alerting them of the findings with suggestions of safer alternative agents, if applicable. The recommendation acceptance rate was assessed and then compared with a historical control from a similar time frame. The primary outcome was assessed with a chi square analysis. Secondary outcomes were assessed with descriptive statistics, chi square test, and Fisher's exact test. RESULTS: HRME and/or Rx-DIS interactions were changed 25.9[%] of the time in the pharmacist intervention group compared with only 2.0[%] of the time in the historical control group (P = 0.001). The most frequently changed medication classes included skeletal muscle relaxants, benzodiazepines, and nonsteroidal anti-inflammatory drugs. Over 85[%] of the medication changes were preserved at the end of the study period. There was no difference between groups in the number of patients with HRME or Rx-DIS interactions. CONCLUSIONS: Clinical pharmacy interventions result in significant reductions in use of HRME and Rx-DIS interactions in the outpatient elderly population. Using electronic communication allows pharmacists to provide meaningful interventions for numerous patients receiving care in a highvolume family medicine clinic setting.

Original languageEnglish (US)
Pages (from-to)520-524
Number of pages5
JournalJournal of Managed Care and Specialty Pharmacy
Volume23
Issue number5
DOIs
StatePublished - May 1 2017

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Outpatients
Pharmacists
Medicine
Neuromuscular Agents
Electronic medical equipment
Benzodiazepines
Delivery of Health Care
Pharmaceutical Preparations
Electronic Health Records
Anti-Inflammatory Agents
Emergency Medical Services
Chi-Square Distribution
Hospital Mortality
Statistics
Population
Primary Health Care
Patient Care
Cohort Studies
Retrospective Studies
Communication

All Science Journal Classification (ASJC) codes

  • Pharmacy
  • Pharmaceutical Science
  • Health Policy

Cite this

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title = "Assessment of clinical pharmacy interventions to reduce outpatient use of high-risk medications in the elderly",
abstract = "BACKGROUND: Use of high-risk medications in the elderly (HRME) and drug-disease (Rx-DIS) interactions in the elderly, as defined by the Healthcare Effectiveness Data and Information Set (HEDIS) Measures, are significantly associated with mortality, hospital admission, and need for emergency care. No published studies to date evaluate interventions to reduce the use of HEDIS-defined HRME, although many studies have postulated a beneficial effect of such interventions. OBJECTIVE: To evaluate the effect of pharmacist interventions on use of HRME and Rx-DIS interactions in the outpatient elderly population. METHODS: This retrospective cohort study was conducted in a residentbased family medicine clinic. Patients aged = 65 years were prospectively screened for the use of HRME and Rx-DIS interactions before their visits with their primary care providers. If HRME or Rx-DIS interactions were noted, the clinical pharmacist sent messages to the physicians through the electronic medical record, alerting them of the findings with suggestions of safer alternative agents, if applicable. The recommendation acceptance rate was assessed and then compared with a historical control from a similar time frame. The primary outcome was assessed with a chi square analysis. Secondary outcomes were assessed with descriptive statistics, chi square test, and Fisher's exact test. RESULTS: HRME and/or Rx-DIS interactions were changed 25.9[{\%}] of the time in the pharmacist intervention group compared with only 2.0[{\%}] of the time in the historical control group (P = 0.001). The most frequently changed medication classes included skeletal muscle relaxants, benzodiazepines, and nonsteroidal anti-inflammatory drugs. Over 85[{\%}] of the medication changes were preserved at the end of the study period. There was no difference between groups in the number of patients with HRME or Rx-DIS interactions. CONCLUSIONS: Clinical pharmacy interventions result in significant reductions in use of HRME and Rx-DIS interactions in the outpatient elderly population. Using electronic communication allows pharmacists to provide meaningful interventions for numerous patients receiving care in a highvolume family medicine clinic setting.",
author = "Weddle, {Sarah C.} and Anthony Rowe and Julie Jeter and Renwick, {Rachel C.} and Shaunta' Chamberlin and Andrea Franks",
year = "2017",
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doi = "10.18553/jmcp.2017.23.5.520",
language = "English (US)",
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T1 - Assessment of clinical pharmacy interventions to reduce outpatient use of high-risk medications in the elderly

AU - Weddle, Sarah C.

AU - Rowe, Anthony

AU - Jeter, Julie

AU - Renwick, Rachel C.

AU - Chamberlin, Shaunta'

AU - Franks, Andrea

PY - 2017/5/1

Y1 - 2017/5/1

N2 - BACKGROUND: Use of high-risk medications in the elderly (HRME) and drug-disease (Rx-DIS) interactions in the elderly, as defined by the Healthcare Effectiveness Data and Information Set (HEDIS) Measures, are significantly associated with mortality, hospital admission, and need for emergency care. No published studies to date evaluate interventions to reduce the use of HEDIS-defined HRME, although many studies have postulated a beneficial effect of such interventions. OBJECTIVE: To evaluate the effect of pharmacist interventions on use of HRME and Rx-DIS interactions in the outpatient elderly population. METHODS: This retrospective cohort study was conducted in a residentbased family medicine clinic. Patients aged = 65 years were prospectively screened for the use of HRME and Rx-DIS interactions before their visits with their primary care providers. If HRME or Rx-DIS interactions were noted, the clinical pharmacist sent messages to the physicians through the electronic medical record, alerting them of the findings with suggestions of safer alternative agents, if applicable. The recommendation acceptance rate was assessed and then compared with a historical control from a similar time frame. The primary outcome was assessed with a chi square analysis. Secondary outcomes were assessed with descriptive statistics, chi square test, and Fisher's exact test. RESULTS: HRME and/or Rx-DIS interactions were changed 25.9[%] of the time in the pharmacist intervention group compared with only 2.0[%] of the time in the historical control group (P = 0.001). The most frequently changed medication classes included skeletal muscle relaxants, benzodiazepines, and nonsteroidal anti-inflammatory drugs. Over 85[%] of the medication changes were preserved at the end of the study period. There was no difference between groups in the number of patients with HRME or Rx-DIS interactions. CONCLUSIONS: Clinical pharmacy interventions result in significant reductions in use of HRME and Rx-DIS interactions in the outpatient elderly population. Using electronic communication allows pharmacists to provide meaningful interventions for numerous patients receiving care in a highvolume family medicine clinic setting.

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