David O'Sullivan1, Denis O'Mahony2,3, Marie N O'Connor2, Paul Gallagher2,3, James Gallagher1, Shane Cullinan1, Richard O'Sullivan1, Joseph Eustace4, Stephen Byrne5,6. 1. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland. 2. Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland. 3. School of Medicine, College of Medicine and Health Sciences, Brookfield Complex, University College Cork, Cork, Ireland. 4. Health Research Board of Ireland Clinical Research Facility, University College Cork, Cork, Ireland. 5. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland. stephen.byrne@ucc.ie. 6. Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland. stephen.byrne@ucc.ie.
Abstract
BACKGROUND: Proven interventions to reduce adverse drug reactions (ADRs) in older hospitalised patients are lacking. Previous randomised controlled trial (RCT) data indicate that a structured pharmacist review of medication (SPRM) can reduce inappropriate prescribing in older hospitalised patients. However, no RCT data show that an SPRM reduces ADRs in this population. METHODS: We performed a cluster RCT comparing a clinical decision support software (CDSS)-supported SPRM intervention with standard pharmaceutical care in older patients hospitalised with an acute unselected illness. Over 13 months, we screened 1833 patientsaged ≥65 years admitted to specialist services other than geriatric medicine for study inclusion. We randomised 361 patients to the trial intervention arm and 376 patients to the control arm, applying the intervention at a single timepoint within 48 h of admission. The primary endpoint (ADR incidence) was assessed at 7-10 days post-admission or at discharge (whichever came first). The secondary endpoints were the median hospital length of stay (LOS) and hospital mortality rate. RESULTS: Attending clinicians in the intervention group implemented 54.8% of SPRM/CDSS prescribing recommendations. Ninety-one ADRs occurred in 78 control patients (20.7%) compared with 61 ADRs in 50 intervention patients (13.9%), i.e., an absolute risk reduction of 6.8%. The number needed to treat (NNT) to prevent one patient having one ADR was 15; the total NNT to prevent one ADR was 14. The median LOS and hospital mortality were not significantly different. CONCLUSION: An SPRM delivered on a CDSS platform significantly reduces ADR incidence in acutely hospitalised older people.
RCT Entities:
BACKGROUND: Proven interventions to reduce adverse drug reactions (ADRs) in older hospitalised patients are lacking. Previous randomised controlled trial (RCT) data indicate that a structured pharmacist review of medication (SPRM) can reduce inappropriate prescribing in older hospitalised patients. However, no RCT data show that an SPRM reduces ADRs in this population. METHODS: We performed a cluster RCT comparing a clinical decision support software (CDSS)-supported SPRM intervention with standard pharmaceutical care in older patients hospitalised with an acute unselected illness. Over 13 months, we screened 1833 patients aged ≥65 years admitted to specialist services other than geriatric medicine for study inclusion. We randomised 361 patients to the trial intervention arm and 376 patients to the control arm, applying the intervention at a single timepoint within 48 h of admission. The primary endpoint (ADR incidence) was assessed at 7-10 days post-admission or at discharge (whichever came first). The secondary endpoints were the median hospital length of stay (LOS) and hospital mortality rate. RESULTS: Attending clinicians in the intervention group implemented 54.8% of SPRM/CDSS prescribing recommendations. Ninety-one ADRs occurred in 78 control patients (20.7%) compared with 61 ADRs in 50 intervention patients (13.9%), i.e., an absolute risk reduction of 6.8%. The number needed to treat (NNT) to prevent one patient having one ADR was 15; the total NNT to prevent one ADR was 14. The median LOS and hospital mortality were not significantly different. CONCLUSION: An SPRM delivered on a CDSS platform significantly reduces ADR incidence in acutely hospitalised older people.
Authors: J T Hanlon; M Weinberger; G P Samsa; K E Schmader; K M Uttech; I K Lewis; P A Cowper; P B Landsman; H J Cohen; J R Feussner Journal: Am J Med Date: 1996-04 Impact factor: 4.965
Authors: Emma C Davies; Christopher F Green; Stephen Taylor; Paula R Williamson; David R Mottram; Munir Pirmohamed Journal: PLoS One Date: 2009-02-11 Impact factor: 3.240
Authors: Shelly L Gray; Laura A Hart; Subashan Perera; Todd P Semla; Kenneth E Schmader; Joseph T Hanlon Journal: J Am Geriatr Soc Date: 2017-12-19 Impact factor: 5.562
Authors: Gary L O'Brien; Denis O'Mahony; Paddy Gillespie; Mark Mulcahy; Valerie Walshe; Marie N O'Connor; David O'Sullivan; James Gallagher; Stephen Byrne Journal: Drugs Aging Date: 2018-08 Impact factor: 3.923