Medication appropriateness on an acute geriatric care unit: the impact of the removal of a clinical pharmacist

Abstract

Abstract Background evidence is largely available indicating benefits to adding a pharmacist on acute care wards. The benefits of maintaining pharmacotherapeutic consultant services on a geriatric ward remain unexplored. Objectives to determine the impact of the removal of a clinical pharmacist from an acute geriatric ward on patients’ Medication Appropriateness Index (MAI) scores, admission-related outcomes and drug burdens. Methods researchers consulted the archives for records of patients admitted to the geriatric care unit before and after the pharmacist’s withdrawal. The primary outcome of differential MAI scores and secondary outcomes of rehospitalisations, emergency department visits, durations of hospitalisation and differential drug count were compared pre- and post-intervention. An interrupted time series analysis regression model was used for the primary outcome. Results a total of 305 patients admitted before (n = 208) and after (n = 97) the pharmacist’s withdrawal were included in the study. The intervention had a significant impact on the primary outcome, increasing the relative differential MAI score (adjusted mean) by 9.3 points (95% confidence interval 3.9–14.6). As for the secondary outcomes, differences in admission-related outcomes were non-significant but the mean differential drug count significantly increased post-intervention from 0.02 to 1.36 (P < 0.001). Conclusion the removal of the pharmacist led to an increase in inappropriate drug prescription. Careful consideration should be given to decisions regarding the removal of the pharmacist from acute geriatric care teams.