Farmacia Hospitalaria | 2021
Intervención del farmacéutico en la prescripción potencialmente inapropiada en pacientes polimedicados: Protocolo ensayo clínico PHARM-PC
Abstract
Objective: Polypharmacy and potentially inappropriate medications\xa0(that\xa0 is, those associated with an unfavorable risk-benefit ratio) are common\xa0concerns in the context of elderly patients treated in primary care as\xa0they may increase the risk of morbidity and mortality, as well as\xa0 healthcare\xa0costs. Several studies have assessed the impact of pharmacist- led\xa0systematic reviews with respect to prescription appropriateness, health\xa0outcomes and/or costs. However, no cluster-randomized controlled\xa0 trial\xa0has been identified that provides an overall assessment of these\xa0 variables.\xa0The objective is to determine the effectiveness of a pharmacist- led systematic\xa0medication review in reducing the mean number and proportion of\xa0patients on potentially inappropriate medications (primary\xa0 goal); as well\xa0as in decreasing morbidity and mortality and the cost of\xa0 medications and\xa0the use of healthcare resources (secondary goals). Method: An open-label, cluster-randomized controlled trial will be\xa0conducted; where primary care physicians will be randomized either to\xa0receive (intervention group) or not to receive pharmacist\xa0 recommendations\xa0to withdraw potentially inappropriate medications\xa0 detected through the\xa0combined use of explicit and implicit criteria (control\xa0 group). Primary end-points will be the proportion of patients on potentially inappropriate medications and the mean number of such medications per\xa0 patient. Secondary endpoints will be healthcare resources used, the\xa0 proportion of patients who die and the mean number of days survived, as\xa0 well as the cost of medications and cost of healthcare resources used. Conclusions: In line with similar reports and based on our study´s\xa0design, we hope to obtain statistically significant reductions in the use\xa0 of\xa0potentially inappropriate medications and in medication costs overall.\xa0 We\xa0do not however expect to obtain significant reductions in\xa0 morbimortality or\xa0the cost of health resources employed.