Impact of pharmacist identification of medication-related problems in a nontraditional long-term care pharmacy

To characterize the most common medication-related problems and interventions and to evaluate the acceptance rates of pharmacist identification of medication-related problems through percent acceptance rates of interventions in a nontraditional long-term care pharmacy.

A retrospective chart review of long-term care pharmacy patients 18 years of age or older was used to evaluate pharmacist interventions from January 2014 to August 2016. Data collection included the date and type of intervention, patient demographic information (age, sex), drug class involved, physician provider type (primary care or specialist), intervention outcome, and resolution type. Accepted and rejected interventions were reviewed and classified based on Hepler and Strand's 8 medication-related problems: untreated indications, improper drug selection, subtherapeutic dosage, failure to receive medication, overdosage, adverse drug reactions, drug interactions, and medication use without indication. Data were analyzed with the use of descriptive statistics.

Four hundred seventeen interventions were documented over 18 months, approximately 13 interventions per month. Prescribers accepted 47% of interventions and rejected 29%. The remaining 24% of interventions did not have a response from the prescriber. Of the medication-related problems, "untreated indication" and "overdosage" were the most commonly intervened with and accepted interventions. Regarding drug class, pharmacists made the most interventions regarding immunizations (41%), diabetes medications (11%), cholesterol medications (10%), and hypertension medications (7%).

Pharmacists are improving the care of patients living in small group homes through various types of recommendations regarding complex disease states, such as diabetes, hyperlipidemia, and hypertension, further complicated by mental illness. With almost one-half of all recommendations accepted by prescribers, pharmacists consistently provided recommendations to improve care.