Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions

J Am Med Dir Assoc. 2012 May;13(4):406.e1-7. doi: 10.1016/j.jamda.2011.03.008. Epub 2011 May 18.

Abstract

Background: Potentially inappropriate medications and prescription omissions (PO) are highly prevalent in older patients with mental comorbidities.

Objective: To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing.

Design: Prospective and interventional study.

Setting: Medical-psychiatric unit in an academic geriatric department.

Participants: Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition.

Intervention: From admission to discharge, daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team.

Measurements: Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge.

Results: Compared with admission, the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 (P < .0001) and incidence rates for potentially inappropriate medications and PO reduced from 77% to 19% (P < .0001) and from 65% to 11% (P < .0001), respectively. Independent predictive factors for PIP at discharge were being a faller (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.43-2.09) and for PO, the increased number of medications (OR 1.54; 95% CI 1.13-1.89) and a Charlson comorbidity index greater than 2 (OR 1.85; 95% CI 1.38 - 2.13). Dementia and/or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge.

Conclusion: These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population. Further evaluations are, however, still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes, such as incidence of adverse drug events, rehospitalization, or mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Acute Disease / therapy
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Cognition Disorders / diagnosis
  • Cognition Disorders / drug therapy*
  • Cognition Disorders / epidemiology
  • Comorbidity
  • Drug-Related Side Effects and Adverse Reactions*
  • Female
  • Follow-Up Studies
  • Geriatric Assessment / methods
  • Geriatrics / methods
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inappropriate Prescribing / adverse effects*
  • Inappropriate Prescribing / statistics & numerical data
  • Interdisciplinary Communication*
  • Male
  • Medication Errors / prevention & control
  • Medication Errors / statistics & numerical data
  • Mental Disorders / drug therapy*
  • Mental Disorders / epidemiology*
  • Needs Assessment
  • Pharmaceutical Preparations / administration & dosage
  • Prevalence
  • Prospective Studies
  • Psychiatry / methods
  • Quality Control
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Pharmaceutical Preparations