Benefits of pharmaceutical care services in optimizing pharmacotherapy in the elderly

Objectives: Treatment optimization is a major public health issue in the elderly. Different tools like the explicit criteria STOPP and START have been developed in order to guide physicians and pharmacists in this process. The objective of this study was to assess the benefits of pharmaceutical care (PC) on prescriptions revaluation in this specific population. Methods: An observational study has been conducted in a 2000-beds teaching hospital. All patients over 75 years old hospitalized in 20 care units (CU), including 10 with PC, were enrolled to compare prescriptions at admission and discharge according to STOPP criteria version 2. Pharmaceutical interventions (PI) performed were collected. Results: Among the 166 patients included, 55%were admitted in units with PC. At admission, 74 and 76 potential inappropriate prescribing (PIP) were observed in units with PC and others, respectively. During hospitalization, the revaluation rate of PIP was 53% and 59%, respectively (p > 0.05). In PC units, 150 PI were proposed in which 7 conducted to stop potentially inappropriate prescriptions. The majority of PI concerned request for dose adjustment (27.3%) drug renewal at admission (20.7%), substitutions proposals according to the drug formulary of our institution (16.0%) or suggestions for discontinuation treatment (12.7%). Conclusion: Explicit criteria allow a first approach to revaluation of prescription by targeting the most high risks drugs. However they don't cover all the complexity of optimizing prescriptions. Further assistances coming from PC activity suggest other areas of improvement, making multidisciplinary collaboration involving clinical pharmacists essential.