Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit

To assess the pharmacist's contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital.

Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22.

We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006).

The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.