Effects of medication reduction in outpatients with polypharmacy
following medication review by pharmacists
Abstract
Rationale, aims and objectives: Polypharmacy is a risk factor for the
health and safety of elderly patients. To determine whether pharmacists
could reduce the number of medications administered to patients with
polypharmacy in a clinical setting via counselling and medical review.
Method: The assigned clinical pharmacists conducted a medication review
of outpatients at the Showa University Hospital. When a
medication-related risk was identified, the pharmacists counseled the
patients. We retrospectively surveyed the medical records of 13
outpatients who received interventions (medication review and
counseling) by clinical pharmacists between January 2017 and June 2017.
Adverse events or changes in the physical conditions of patients were
assessed for 6 months. The suitability of medications was assessed using
the medication appropriateness index (MAI) by two pharmacists before the
review and 6 months post-review. Results: The number of coadministered
medications was 17 (9–30) [median (range)] before the intervention;
it significantly reduced to 8 (8–29) just after the intervention and to
13 (8–27) 6 months post-intervention. The MAI score was sustained for
up to 6 months after the intervention (before vs. just after and 6
months after the intervention: 9 [3–23] vs. 4 [0–22] and 2
[0–23], p < 0.005). No adverse events were observed for 6
months. Conclusions: Pharmaceutical counseling and medication review by
clinical pharmacists reduced polypharmacy without any adverse events for
at least 6 months despite limited number of assessments. Thus,
interventions (medication review and counseling) by clinical pharmacists
are a useful method to resolve polypharmacy in outpatients.