Screening for adverse drug events in older adults: the impact of interventions.

OBJECTIVE: Primary, to evaluate the usefulness of a comprehensive medication review (CMR) process in screening for adverse drug event (ADE) risk and to measure the impact of pharmacist recommendations; secondary, to evaluate whether screening tools assist in detecting ADEs.

DESIGN: Nonrandomized, prospective pre/post pilot study.

SETTING: Wisconsin-based community pharmacy affiliated with a two-campus retirement facility serving independently living older adults.

PARTICIPANTS: Sixty-nine older adults responded to the initial call for participation in the ADE screening (mean age 84 years, mean daily medications: 13.7). Thirty-nine older adults (mean age 86 years, mean daily medications: 13.8) participated in both pre/post pilot study phases.

INTERVENTION: Each participant received a CMR, including self-identified geriatric syndromes and St. Louis University Memory Screen (SLUMS) assessment. Recommendation letters included lifestyle changes to reduce medication use. A three-month follow-up call gathered current medication lists and recommendation acceptance rates. Repeat screenings were also conducted.

MAIN OUTCOME MEASURE(S): Number of ADEs identified, recommendation acceptance rates, medication-related changes. Secondary measures: self-reported geriatric syndromes, SLUMS scores associated with ADE identification, screening tools associated with ADE identification.

RESULTS: Pharmacist-initiated CMRs resulted in a high rate of discontinued nonsteroidal anti-inflammatory drugs (NSAIDs) and overall reduction in the number of scheduled medications. Participants with a positive ADE history were significantly more likely to report a suspected current ADE. Pharmacists incorporated nonpharmacologic interventions for reported geriatric syndromes, with high participant acceptance rates. In isolated cases, cognition was measurably improved with discontinuation of a targeted medication.

CONCLUSIONS: Pharmacist-provided CMR services should be comprehensive, including patient's self-report of ADEs and history of ADEs. Pharmacist intervention can minimize prescription medication use, reducing the risk of ADEs.