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

dc.check.embargoformatNot applicableen
dc.check.infoNo embargo requireden
dc.check.opt-outNot applicableen
dc.check.reasonNo embargo requireden
dc.check.typeNo Embargo Required
dc.contributor.advisorByrne, Stephenen
dc.contributor.advisorO'Mahony, Denis
dc.contributor.authorO'Sullivan, David.
dc.contributor.funderHealth Research Boarden
dc.contributor.funderCentre for Ageing Research and Development in Irelanden
dc.date.accessioned2015-08-13T10:55:47Z
dc.date.available2015-08-13T10:55:47Z
dc.date.issued2014
dc.date.submitted2014
dc.description.abstractIntroduction: 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.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationO'Sullivan, D. 2014. Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention. PhD Thesis, University College Cork.en
dc.identifier.endpage328
dc.identifier.urihttps://hdl.handle.net/10468/1900
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2013, David O'Sullivan.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectPharmacisten
dc.subjectInterventionsen
dc.subjectPolypharmacyen
dc.subjectElderlyen
dc.subjectPotentially inappropriate prescribingen
dc.subjectAdverse drug reactionsen
dc.subjectStructured pharmacist interventionsen
dc.subjectDrug related problemsen
dc.subjectSecondary careen
dc.subjectPotential precribing omissionen
dc.subjectMedication reconciliationen
dc.thesis.opt-outfalse
dc.titlePharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and interventionen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD (Medicine and Health)en
ucc.workflow.supervisorstephen.byrne@ucc.ie
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