PMID- 28448781 OWN - NLM STAT- MEDLINE DCOM- 20180111 LR - 20230805 IS - 2376-1032 (Electronic) IS - 2376-0540 (Print) IS - 2376-0540 (Linking) VI - 23 IP - 5 DP - 2017 May TI - Assessment of Clinical Pharmacy Interventions to Reduce Outpatient Use of High-Risk Medications in the Elderly. PG - 520-524 LID - 10.18553/jmcp.2017.23.5.520 [doi] AB - BACKGROUND: Use of high-risk medications in the elderly (HRME) and drug-disease (Rx-DIS) interactions in the elderly, as defined by the Healthcare Effectiveness Data and Information Set (HEDIS) Measures, are significantly associated with mortality, hospital admission, and need for emergency care. No published studies to date evaluate interventions to reduce the use of HEDIS-defined HRME, although many studies have postulated a beneficial effect of such interventions. OBJECTIVE: To evaluate the effect of pharmacist interventions on use of HRME and Rx-DIS interactions in the outpatient elderly population. METHODS: This retrospective cohort study was conducted in a resident-based family medicine clinic. Patients aged >/= 65 years were prospectively screened for the use of HRME and Rx-DIS interactions before their visits with their primary care providers. If HRME or Rx-DIS interactions were noted, the clinical pharmacist sent messages to the physicians through the electronic medical record, alerting them of the findings with suggestions of safer alternative agents, if applicable. The recommendation acceptance rate was assessed and then compared with a historical control from a similar time frame. The primary outcome was assessed with a chi square analysis. Secondary outcomes were assessed with descriptive statistics, chi square test, and Fisher's exact test. RESULTS: HRME and/or Rx-DIS interactions were changed 25.9% of the time in the pharmacist intervention group compared with only 2.0% of the time in the historical control group (P = 0.001). The most frequently changed medication classes included skeletal muscle relaxants, benzodiazepines, and nonsteroidal anti-inflammatory drugs. Over 85% of the medication changes were preserved at the end of the study period. There was no difference between groups in the number of patients with HRME or Rx-DIS interactions. CONCLUSIONS: Clinical pharmacy interventions result in significant reductions in use of HRME and Rx-DIS interactions in the outpatient elderly population. Using electronic communication allows pharmacists to provide meaningful interventions for numerous patients receiving care in a high-volume family medicine clinic setting. DISCLOSURES: There was no funding or sponsorship for this study. Rowe reports personal fees from The Medicines Company, outside the submitted work. The other authors have nothing to disclose. Study concept and design were contributed by Jeter, Chamberlin, and Weddle, with assistance from Rowe and Franks. Weddle and Renwick collected the data, and data interpretation was performed by Weddle and Rowe, with assistance from Franks. The manuscript was written by Weddle and Rowe and revised by Weddle and Franks, assisted by Chamberlin. The abstract for the completed study was presented at the American College of Clinical Pharmacy Global Conference, San Francisco, California, October 2015, and the Southeastern Residency Conference, Athens, Georgia, April 2015 (platform presentation). The research-in-progress abstract was presented at the Tennessee Society of Health System Pharmacists, Nashville, Tennessee, February 2015; the American Society of Health System Pharmacists Midyear Clinical Meeting, Anaheim, California, December 2014; and the University HealthSystem Consortium Pharmacy Council, Anaheim, California, December 2014. FAU - Weddle, Sarah C AU - Weddle SC AD - 1 University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy, and the University of Tennessee Medical Center, Department of Pharmacy, Knoxville. FAU - Rowe, A Shaun AU - Rowe AS AD - 1 University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy, and the University of Tennessee Medical Center, Department of Pharmacy, Knoxville. FAU - Jeter, Julie W AU - Jeter JW AD - 2 University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville. FAU - Renwick, Rachel C AU - Renwick RC AD - 1 University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy, and the University of Tennessee Medical Center, Department of Pharmacy, Knoxville. FAU - Chamberlin, Shaunta' M AU - Chamberlin SM AD - 3 University of Tennessee Medical Center, Department of Pharmacy, and University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville. FAU - Franks, Andrea S AU - Franks AS AD - 4 University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy; University of Tennessee Medical Center, Department of Pharmacy; and University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville. LA - eng PT - Journal Article PL - United States TA - J Manag Care Spec Pharm JT - Journal of managed care & specialty pharmacy JID - 101644425 RN - 0 (Pharmaceutical Preparations) SB - IM MH - Aged MH - Aged, 80 and over MH - Cohort Studies MH - Drug-Related Side Effects and Adverse Reactions/*prevention & control MH - Female MH - Humans MH - Male MH - *Medication Therapy Management MH - Outpatients MH - Pharmaceutical Preparations/administration & dosage MH - Pharmacists/*organization & administration MH - Pharmacy Service, Hospital/*organization & administration MH - Retrospective Studies PMC - PMC10397936 COIS- There was no funding or sponsorship for this study. Rowe reports personal fees from The Medicines Company, outside the submitted work. The other authors have nothing to disclose. Study concept and design were contributed by Jeter, Chamberlin, and Weddle, with assistance from Rowe and Franks. Weddle and Renwick collected the data, and data interpretation was performed by Weddle and Rowe, with assistance from Franks. The manuscript was written by Weddle and Rowe and revised by Weddle and Franks, assisted by Chamberlin. The abstract for the completed study was presented at the American College of Clinical Pharmacy Global Conference, San Francisco, California, October 2015, and the Southeastern Residency Conference, Athens, Georgia, April 2015 (platform presentation). The research-in-progress abstract was presented at the Tennessee Society of Health System Pharmacists, Nashville, Tennessee, February 2015; the American Society of Health System Pharmacists Midyear Clinical Meeting, Anaheim, California, December 2014; and the University HealthSystem Consortium Pharmacy Council, Anaheim, California, December 2014. EDAT- 2017/04/28 06:00 MHDA- 2018/01/13 06:00 PMCR- 2017/05/01 CRDT- 2017/04/28 06:00 PHST- 2017/04/28 06:00 [entrez] PHST- 2017/04/28 06:00 [pubmed] PHST- 2018/01/13 06:00 [medline] PHST- 2017/05/01 00:00 [pmc-release] AID - 10.18553/jmcp.2017.23.5.520 [doi] PST - ppublish SO - J Manag Care Spec Pharm. 2017 May;23(5):520-524. doi: 10.18553/jmcp.2017.23.5.520.