[Medication reconciliation in patients over 75 years]

Area of Science:

• Geriatric Medicine
• Clinical Pharmacy
• Patient Safety

Background:

• Medication reconciliation is crucial for older adults due to polypharmacy and increased risk of adverse drug events.
• Potentially inappropriate prescriptions (PIPs) and drug interactions are common in elderly patients, leading to hospitalizations and morbidity.
• Systematic medication review processes are needed to optimize pharmacotherapy in geriatric populations.

Purpose of the Study:

• To implement and evaluate medication reconciliation on hospital admission and discharge for patients over 75.
• To analyze potentially inappropriate prescriptions using the Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right (indicated) Treatment (STOPP/START) criteria.
• To identify clinically relevant drug interactions in this patient cohort.

Main Methods:

• Retrospective observational study of 818 patients aged over 75 undergoing medication reconciliation.
• Classification of discrepancies using the "Consensus Document on Terminology and Classification in Medication Reconciliation".
• Application of STOPP/START criteria and review of drug interactions; development of patient information materials for discharge.

Main Results:

• Medication reconciliation achieved 42.3% coverage, identifying reconciliation errors in 23.4% on admission and 22.5% at discharge.
• Potentially inappropriate prescriptions (STOPP/START) were found in 6.0% of patients.
• Clinically relevant drug interactions affected 11.7% of reconciled patients.

Conclusions:

• Medication reconciliation effectively detects errors between patients' chronic medications and hospital prescriptions.
• The STOPP/START criteria are valuable for identifying common potentially inappropriate prescriptions in elderly patients.
• Analysis of drug interactions highlights combinations to be avoided in this vulnerable population, improving medication safety.