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Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome

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Abstract

Background

Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions.

Objectives

Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients.

Methods

A monocentric, prospective controlled trial was undertaken at the geriatric wards of a large university hospital. Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review, upon which recommendations were provided to the treating physicians. The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission. Secondary outcomes included RASP-identified potentially inappropriate medications (PIMs), the number of Emergency Department (ED) visits and quality of life (QOL) registered up to 3 months after discharge.

Results

On average, patients (n = 172) took 10 drugs on admission and were 84.5 years (standard deviation 4.8) of age. More drugs were discontinued or reduced in dose in the intervention group {control vs. intervention: median (interquartile range [IQR]) 3 (2–5) vs. 5 (3–7); p < 0.001}. More PIMs were discontinued in the intervention group, leading to less PIM at discharge [control vs. intervention: median (IQR) 2 (1–3) vs. 0.5 (0–1); p < 0.001]. No signal of harm was seen, and a significant improvement of QOL and less ED visits without hospitalization were observed.

Conclusions

The combined intervention safely reduced drug use in very old inpatients and outperformed usual geriatric care. An increased QOL was seen, as well as a trend towards less ED visits.

ClinicalTrials.gov Identifier: NCT01513265.

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Acknowledgements

The authors wish to thank Siska Desplenter and Elien Brants for assisting in the follow-up of patients during hospital stay and also in performing follow-up telephone interviews.

Author contributions

Lorenz Van der Linden and Liesbeth Decoutere participated in the study concept and design, acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. Karolien Walgraeve participated in the acquisition of subjects and data and preparation of the manuscript. Jos Tournoy, Isabel Spriet and Johan Flamaing participated in the study concept and design, analysis of data and preparation of the manuscript. Koen Milisen participated in the interpretation of data and preparation of the manuscript.

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Correspondence to Lorenz Van der Linden.

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Funding

No sources of funding were used to assist in the conduct of this study or the preparation of this article.

Conflict of interest

Lorenz Van der Linden, Liesbeth Decoutere, Karolien Walgraeve, Koen Milisen, Johan Flamaing, Isabel Spriet and Jos Tournoy declare that they have no conflicts of interest relevant to the content of this article.

Consent

This trial was approved by the Ethical Committee of the University Hospital Leuven, Leuven, Belgium. Informed consent was obtained prior to enrollment into the study.

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Van der Linden, L., Decoutere, L., Walgraeve, K. et al. Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome. Drugs Aging 34, 123–133 (2017). https://doi.org/10.1007/s40266-016-0424-8

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