Simal Ine, Capiau Andreas, De Spiegeleer Anton, Velghe Anja, Van Den Noortgate Nele, Petrovic Mirko, Somers Annemie
Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.
Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Int J Clin Pharm. 2025 Jun 4. doi: 10.1007/s11096-025-01934-y.
Drug-related problems (DRPs) are prevalent in geriatric patients and associated with poor health outcomes. Clinical pharmacists (CPs) play a key role in optimising medication use, yet the benefits of CP interventions in collaboration with the geriatrician in a geriatric day hospital setting remain underexplored.
This study aimed to: (1) evaluate CP activities at a geriatric day hospital by analysing (a) identified DRPs and recommendations, and (b) the prevalence of potentially inappropriate medications (PIMs), including Fall-Risk Increasing Drugs (FRIDs), at admission/discharge; and (2) examine the acceptance and implementation rates of CPs' recommendations by the attending geriatrician.
All patients that visited the day hospital during 25 non-consecutive days were invited to participate. DRPs and corresponding CPs' recommendations were categorised and analysed. PIMs were identified retrospectively using the Ghent Older People's Prescriptions community Pharmacy Screening-tool version 2.
Ninety-nine patients were included (median age: 85 years, 72.7% female). The most frequently identified DRP was 'no indication'. Drugs used for the nervous system were mostly involved. CPs proposed 251 recommendations (median: two per patient), which most frequently concerned 'stop therapy'. The acceptance rate was 80.1%, of which 73.1% were implemented immediately. The PIM prevalence decreased from 91.8% on admission to 87.6% at discharge (p < .001). The median number of FRIDs was two at both timepoints.
CPs can have a valuable role in the interdisciplinary team at a geriatric day hospital. Regularly reevaluating the appropriate use of drugs used for the nervous system, and initiating judicious deprescribing is recommended.
药物相关问题（DRPs）在老年患者中普遍存在，并与不良健康结局相关。临床药师（CPs）在优化药物使用方面发挥着关键作用，但在老年日间医院环境中，CPs与老年病医生合作进行干预的益处仍未得到充分探索。
本研究旨在：（1）通过分析（a）识别出的DRPs及建议，以及（b）入院/出院时潜在不适当用药（PIMs）的患病率，包括增加跌倒风险的药物（FRIDs），来评估老年日间医院的CP活动；（2）检查主治老年病医生对CPs建议的接受率和实施率。
邀请在25个非连续日期间到日间医院就诊的所有患者参与。对DRPs及相应的CPs建议进行分类和分析。使用根特老年人处方社区药房筛查工具第2版对PIMs进行回顾性识别。
纳入99例患者（中位年龄：85岁，72.7%为女性）。最常识别出的DRP是“无适应症”。涉及的药物主要是用于神经系统的药物。CPs提出了251条建议（中位值：每位患者两条），其中最常见的是“停止治疗”。接受率为80.1%，其中73.1%立即得到实施。PIMs患病率从入院时的91.8%降至出院时的87.6%（p < 0.001）。两个时间点的FRIDs中位数量均为两条。
CPs在老年日间医院的跨学科团队中可发挥重要作用。建议定期重新评估用于神经系统药物的合理使用情况，并明智地启动减药措施。
