Evaluating an integrated clinical pharmacist model in a geriatric day hospital: a prospective single-centre...

Drug-related problems (DRPs) are prevalent in geriatric patients and associated with poor health outcomes. Clinical pharmacists (CPs) play a key role in optimising medication use, yet the benefits of CP interventions in collaboration with the geriatrician in a geriatric day hospital setting remain underexplored.

This study aimed to: (1) evaluate CP activities at a geriatric day hospital by analysing (a) identified DRPs and recommendations, and (b) the prevalence of potentially inappropriate medications (PIMs), including Fall-Risk Increasing Drugs (FRIDs), at admission/discharge; and (2) examine the acceptance and implementation rates of CPs' recommendations by the attending geriatrician.

All patients that visited the day hospital during 25 non-consecutive days were invited to participate. DRPs and corresponding CPs' recommendations were categorised and analysed. PIMs were identified retrospectively using the Ghent Older People's Prescriptions community Pharmacy Screening-tool version 2.

Ninety-nine patients were included (median age: 85 years, 72.7% female). The most frequently identified DRP was 'no indication'. Drugs used for the nervous system were mostly involved. CPs proposed 251 recommendations (median: two per patient), which most frequently concerned 'stop therapy'. The acceptance rate was 80.1%, of which 73.1% were implemented immediately. The PIM prevalence decreased from 91.8% on admission to 87.6% at discharge (p < .001). The median number of FRIDs was two at both timepoints.

CPs can have a valuable role in the interdisciplinary team at a geriatric day hospital. Regularly reevaluating the appropriate use of drugs used for the nervous system, and initiating judicious deprescribing is recommended.