Abstract
Background: Ageing is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review in frail older people lead to optimize medication use. The aims of the study were to identify inappropriate prescription and to assess the results of a medication review in older people, according to their place of residence. Methods: This was a study with paired pre- and post-medication review data based on person-centered prescription, with a follow-up assessment at three months. We recruited patients who lived in the community, either in their own home or in a nursing home. We select patients of 65 years or more with multimorbidity whom his General Practitioner identified difficulties with the prescription management and the need of a medication review. Finally, a medication review was carried out through the application of the Patient-Centered Prescription model. Data collected were: age, sex, place of residence, morbidities, functional and cognitive status, frailty index, number of medications, therapeutical complexity, anticholinergic and/or sedative burden and monthly medication expenditure. The Chi-square test or Fisher's exact test were used to evaluate the relationship between qualitative variables and the patients’ place of residence. Student’s t-test was used to analyze the relationship between quantitative variables and the patients’ place of residence.Results: 428 patients. 90% of people presented at least one inappropriate prescription in both settings. In nursing homes, a higher number of implemented optimization proposals was detected (81.6% versus 65.7% (p<0.001)). Post-medication review, nursing-home patients had a greater decrease in their mean number of medications, polypharmacy prevalence, therapeutic complexity and in monthly medication expenditure (p<0.001). Conclusions: Patient-Centered Prescription model detected a high number of inappropriate prescriptions in both settings. However, once medication was reviewed and optimization proposals implemented, nursing-home patients presented
The effects of a pharmacist-led medication review in a nursing home
