Consultant pharmacist drug therapy recommendations from monthly drug regimen reviews in a geriatric nursing facility: a two-year study and cost analysis.

PURPOSE: To analyze drug therapy recommendations acceptance or rejection costs in a nursing facility practice over 2 years.
METHODS: Admission patient assessment, problem list and monthly problem-oriented drug regimen review (DRR) and assessment , with written report and mandated response by attending physician and follow-up on subsequent months DRR. Descriptive statistics of patient demographics and recommendation acceptance and types. Cost calculation of consequences of acceptance or rejection. SUMMARY OF
RESULTS: In 204 predominantly female patients (age 83.7 +/- 7.8 years), with 4.5 +/- 1.3 active problems per patient, 4,008 monthly drug regimen reviews resulted in 374 recommendations (9.3% of reviews). In decreasing rank order, recommendations were for adverse drug reaction and interaction detection and resolution (156), discontinue medications (74), buspirone conversion from other psychotropic(s) (60), change medications (33), needed nutritional or drug therapy (26), change dose, dosing interval, dosage form, or administration technique (25). The cost savings from recommendation acceptance was $223,218; rejection $224,593.
CONCLUSION: Geriatric long-term care patients appear to have numerous drug-related problems (DRPs) requiring unsolicited consultations, especially adverse drug reactions. Acceptance of consultant pharmacist recommendations may influence cost of overall care.