dc.check.embargoformat	Not applicable	en
dc.check.info	No embargo required	en
dc.check.opt-out	Not applicable	en
dc.check.reason	No embargo required	en
dc.check.type	No Embargo Required
dc.contributor.advisor	Byrne, Stephen	en
dc.contributor.advisor	O'Mahony, Denis
dc.contributor.author	O'Sullivan, David.
dc.contributor.funder	Health Research Board	en
dc.contributor.funder	Centre for Ageing Research and Development in Ireland	en
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.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.description.status	Not peer reviewed	en
dc.description.version	Accepted Version
dc.format.mimetype	application/pdf	en
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	https://hdl.handle.net/10468/1900
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.thesis.opt-out	false
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
ucc.workflow.supervisor	stephen.byrne@ucc.ie

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

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