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A Pharmacist‐Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older HIV ‐Positive Patients
Author(s) -
McNicholl Ian R.,
Gandhi Monica,
Hare C. Bradley,
Greene Meredith,
Pierluissi Edgar
Publication year - 2017
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2043
Subject(s) - medicine , polypharmacy , pharmacist , dyslipidemia , beers criteria , diabetes mellitus , medical prescription , depression (economics) , concomitant , psychological intervention , emergency medicine , physical therapy , disease , family medicine , pharmacy , psychiatry , economics , pharmacology , macroeconomics , endocrinology
Objective The goal of this pharmacist‐led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions ( STOPP ), to assess potentially inappropriate prescribing ( PIP ) in older patients infected with the human immunodeficiency virus ( HIV ) and evaluate pharmacist interventions. Design Prospective randomized interventional trial. Setting Large urban clinic providing interdisciplinary primary and HIV care for ~2700 HIV ‐positive publicly insured patients. Data Source A computerized electronic record search was conducted for all patients who met the two search criteria: 50 years and older, and a primary care appointment within the last 12 months. Patients After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed. Measurements and Main Results Patients had a mean age of 58 years, 71% male, 44% white, and a mean CD 4 count of 536 cells/mm 3 . Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6 ± 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty‐five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist. Conclusions Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist‐led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP , many amenable to immediate clinical pharmacist intervention.