Analysis of clinical outcomes in older individuals who received pharmaceutical care and posthospital discharge follow‐up

• Published in: Journal of evaluation in clinical practice 2024-09, Vol.30 (6), p.1008-1016
• Main Authors: Oliveira, Alan Maicon, Rodrigues, João Paulo Vilela, Campos, Marília Silveira de Almeida, Varallo, Fabiana Rossi, Pereira, Leonardo Régis Leira
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Brazil; Clinical outcomes; Female; Geriatrics; Hospitalization; Hospitals, University; Humans; Male; Medication Reconciliation - methods; Medication Reconciliation - organization & administration; medication review; Older people; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; patient safety; Patient-centered care; Patients; patient‐centred care; pharmaceutical services; Pharmaceutical Services - organization & administration; Pharmaceuticals; Pharmacists; Pharmacy Service, Hospital - organization & administration
• ISSN: 1356-1294; 1365-2753; 1365-2753
• DOI: 10.1111/jep.14010

Background Previous evidence underscores the need to assess potential clinical outcomes resulting from pharmaceutical care interventions and to monitor patient's progress to evaluate their clinical evolution, which is crucial for bolstering the relevance of implementing pharmaceutical care in healthcare services. Aims To conduct an in‐depth analysis of pharmaceutical care practices in a geriatric ward and monitor the clinical outcomes of older people served. Methods This interventionist study was conducted in the geriatrics ward of a Brazilian university hospital. The research intervention occurred between January and May 2022, with a follow‐up conducted for up to 90 days after patients' hospital discharge. Older patients in the geriatrics ward received pharmaceutical care, including medication reconciliation, medication review, and pharmacotherapeutic follow‐up, aimed at identifying and resolving drug‐related problems (DRPs). The clinical relevance of DRPs and pharmaceutical recommendations was evaluated. Additionally, analyses were conducted on mortality and rehospitalization outcomes in older patients at 30, 60, and 90 days following initial hospital discharge. Results Of the patients evaluated, a significant 88.3% exhibited at least one DRP (with an average of 2.6 ± 1.9 DRPs per patient), with the majority classified as need/indication problems (38.9%). The acceptance rate of pharmaceutical recommendations was 80.9%, with the majority categorized as very significant relevance (60.4%). DRPs were predominantly of serious clinical relevance (50.9%). In patients whose clinical indicators could be monitored, 95.5% showed some clinical response (in vital signs, laboratory tests and/or clinical status evolution) potentially related to resolved DRPs. Association analysis revealed that a higher number of medications in use before hospitalization correlated with a greater identification of DRPs during hospitalization (p = 0.03). At hospital discharge, 23.6% of patients were no longer using polypharmacy. In total, 16 patients (26.7%) died during the study period. Among patients who did not die during hospitalization (n = 54), 20 patients (37%) experienced rehospitalizations within 90 days following discharge. Conclusion This study facilitated the consolidation of pharmaceutical care implementation in a geriatric ward. We conducted identification, evaluation, and proposed evidence‐based solutions, as well as monitored cases for outcome analysis. It is anticipated