Pharmacotherapeutic Optimization in a Polymedicated Patient Through Coordinated Pharmaceutical Intervention: A...

Case presentation: An 82-year-old woman, polymedicated (receiving chronic treatment with ten active pharmaceutical ingredients) and independent for basic activities of daily living, was evaluated. Following a hospital consultation due to fatigue and electrolyte disturbances, a family member attended the community pharmacy (CP) with the clinical documentation, requesting support to improve adherence and pharmacotherapy follow-up through repackaging using a Multicompartment Compliance Aid (MCA) [1]. Case study and evaluation: During the initial interview, several Drug-Related Problems (DRPs) were identified: inappropriate dosage of olmesartan/hydrochlorothiazide, combination of diuretics with kaliuretic effect (torasemide and hydrochlorothiazide), prolonged use of omeprazole without current indication, lack of recent laboratory monitoring in the management of hypercholesterolemia, untreated cognitive impairment, and unnecessary prescription of paracetamol. These DRPs posed a risk of generating Negative Outcomes associated with Medication (NOMs) within the three categories established by the Community Pharmacy Pharmaceutical Care Forum: necessity, effectiveness, and safety (2). Intervention: From the community pharmacy, and in coordination with the family and the primary care team, the dosage regimen of olmesartan/hydrochlorothiazide was adjusted, torasemide and paracetamol were discontinued, the atorvastatin dose was modified according to recent laboratory results, and, following specialist recommendation, memantine 10 mg/day together with cognitive stimulation measures was initiated. Results: Serum potassium levels normalized, adequate blood pressure control was achieved, the lipid profile was optimized, and therapeutic adherence improved through the use of the MCA. The patient reported better sleep quality, absence of pain, and greater functional autonomy. Conclusions: Coordinated intervention between community pharmacy, family environment, and primary care allowed optimization of pharmacotherapy, reduction of overmedication, and improvement in quality of life. This case illustrates the clinical and social value of Professional Pharmaceutical Care Services when developed within an integrated care framework, reinforcing the strategic role of community pharmacy in the comprehensive care of older polymedicated patients within a person-centered healthcare model.