A Pharmacist-Physician Intervention Model Using a Computerized Alert System to Reduce High-Risk Medication Use in...

Area of Science:

• Geriatric Medicine
• Clinical Pharmacy
• Pharmacotherapy

Background:

• Potentially inappropriate medication (PIM) use is a significant challenge in elderly inpatients, often leading to adverse drug events and geriatric syndromes.
• Effective strategies are urgently needed to reduce PIM use and improve medication safety in this population.

Purpose of the Study:

• To evaluate a pharmacist-physician intervention model for reducing high-risk medication use in older inpatients.
• To assess the clinical relevance of alerts from a computerized alert system (CAS) designed to identify PIMs.

Main Methods:

• A pharmacist-physician intervention model was implemented in a teaching hospital for patients aged 65 years and older.
• Pharmacists reviewed CAS alerts, analyzed pharmacotherapy, and developed geriatric pharmacotherapeutic plans for physician discussion.
• The primary outcome was the medication change rate following pharmacist intervention.

Main Results:

• A computerized alert system (CAS) flagged alerts in 4.3% of screened patient-days.
• Over 74% of these alerts were deemed clinically relevant.
• The intervention resulted in a medication change rate of 77.7%, primarily through drug discontinuation and dose reduction.

Conclusions:

• The pharmacist-physician intervention model successfully reduced the use of high-risk medications in elderly inpatients.
• The study highlights that many vulnerable patients identified by CAS alerts would not have received a geriatric medication review without this intervention.