Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention

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dc.contributor.advisor Byrne, Stephen en
dc.contributor.advisor O'Mahony, Denis
dc.contributor.author O'Sullivan, David
dc.date.accessioned 2015-08-13T10:55:47Z
dc.date.available 2015-08-13T10:55:47Z
dc.date.issued 2014
dc.date.submitted 2014
dc.identifier.citation O'Sullivan, D. 2014. Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention. PhD Thesis, University College Cork. en
dc.identifier.endpage 328
dc.identifier.uri http://hdl.handle.net/10468/1900
dc.description.abstract Introduction: Older individuals are particularly vulnerable to potentially inappropriate prescribing (PIP), drug related problems (DRPs) and adverse drug reactions (ADRs). A number of different interventions have been proposed to address these issues. However to-date there is a paucity of well-designed trials examining the impact of such interventions. Therefore the aims of this work were to: (i) establish a baseline PIP prevalence both nationally and internationally using the STOPP, Beers and PRISCUS criteria, (ii) identify the most comprehensive method of assessing PIP in older individuals, (iii) develop a structured pharmacist intervention supported by a computer decisions support system (CDSS) and (iv) examine the impact of this intervention on prescribing and incidence of ADRs. Results: This work identified high rates of PIP across all three healthcare settings in Ireland, 84.7% in the long term care, 70.7% in secondary care and 43.3% in primary care being reported. This work identified that for a comprehensive assessment of prescribing to be undertaken, an amalgamation of all three criteria should be deployed simultaneously. High prevalences of DRPs and PIP in older hospitalised individuals were identified. With 82.0% and 76.3% of patients reported to have at least one DRP or PIP instance respectively. The structured pharmacist intervention demonstrated a positive impact on prescribing, with a significant reduction MAI scores being reported. It also resulted in the intervention patients’ having a reduced risk of experiencing an ADR when compared to the control patients (absolute risk reduction of 6.8 (95% CI 1.5% - 12.3%)) and the number needed to treat = 15 (95% CI 8 - 68). However the intervention was found to have no significant effect on length of stay or mortality rate. Conclusion: This work shows that PIP is highly prevalent in older individuals across three healthcare settings in Ireland. This work also demonstrates that a structured pharmacist intervention support by a dedicated CDSS can significantly improve the appropriateness of prescribing and reduce the incidence of ADRs in older acutely ill hospitalised individuals. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2013, David O'Sullivan. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Pharmacist en
dc.subject Interventions en
dc.subject Polypharmacy en
dc.subject Elderly en
dc.subject Potentially inappropriate prescribing en
dc.subject Adverse drug reactions en
dc.subject Structured pharmacist interventions en
dc.subject Drug related problems en
dc.subject Secondary care en
dc.subject Potential precribing omission en
dc.subject Medication reconciliation en
dc.title Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname PhD (Medicine and Health) en
dc.internal.availability Full text available en
dc.check.info No embargo required en
dc.description.version Accepted Version
dc.contributor.funder Health Research Board en
dc.contributor.funder Centre for Ageing Research and Development in Ireland en
dc.description.status Not peer reviewed en
dc.internal.school Pharmacy en
dc.check.type No Embargo Required
dc.check.reason No embargo required en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false
dc.check.embargoformat Not applicable en
ucc.workflow.supervisor stephen.byrne@ucc.ie
dc.internal.conferring Autumn Conferring 2014


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© 2013, David O'Sullivan. Except where otherwise noted, this item's license is described as © 2013, David O'Sullivan.
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