Aspects on optimisation of drug therapy in the elderly

Abstract: Introduction: Elderly patients often use many drugs, increasing the risk for drug-related problems. Aim: To optimise drug therapy in the elderly by identifying, resolving and preventing drug-related problems. Methods: (Paper I) Medication reviews were conducted on nursing home patients’ with epilepsy or Parkinson’s disease by a multi-speciality team, whom identified drug-related problems and when appropriate suggested therapy changes to the intervention patients’ responsible physician. The effect of this intervention was evaluated on health-related quality of life. (Paper II) GPs’ and nurses’ opinions towards the previous pharmacotherapeutic intervention, in Paper I, were evaluated using a questionnaire. (Paper III) Medication errors during the transfer between primary care and hospital were investigated for patient providing care by the community, by collecting and reviewing all medication notes used for the information transfer. (Paper IV) Clinical pharmacists interviewed patients admitted to the hospital using the developed Structured Medication Questionnaire, to identify medication errors and assess patients’ compliance to and beliefs about medicines. (Paper V) Systematic medication reviews and medication care plans were conducted on intervention inpatients, by a multidisciplinary team, to reduce the number of unidentified drug-related problems during the hospital stay, which were identified and evaluated retrospectively. The physicians’ and nurses’ opinions towards this working model were evaluated using a questionnaire. Result: (Paper I) Many drug-related problems were identified among the nursing home patients, but no improvement in health-related quality of life. (Paper II) Both GPs and nurses were positive towards further cooperation regarding pharmacotherapeutic interventions. (Paper III) On average two medication errors occurred each time a patient was transferred between primary and secondary care. (Paper IV) A majority of the patients (62%, CI 45-77%) had at least one medication error. Using this questionnaire, poor compliance and negative beliefs were also identified. (Paper V) Inpatients in the intervention group benefited from a reduction of unidentified drug-related problems. In general physicians and nurses were very positive towards this working model. Conclusion: The research comprising this thesis has demonstrated a need for attention towards drug treatment and drug-related problems in the elderly. The Structured Medication Questionnaire and structured medication reviews may be used as tools to identify drug-related problems. Once identified the drug-related problems have the potential to be prevented or resolved, thereby optimising drug therapy.