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Volume 20 - Issue 6, November-December 2018
ORIGINAL
THE PHARMACEUTICAL CARE DIMINISHES THE PREVALENCE OF CLINICALLY RELEVANT DRUG-DRUG INTERACTIONS IN NURSING HOMES
GONZÁLEZ MARTÍNEZ MARÍA, APOLO CARVAJAL FRANCISCO, ALIOTO DANIELE, MARTÍNEZ CASANOVA NURIA, CAÑAMARES ORBIS ICÍAR, MARTÍNEZ SÁNCHEZ EUGENIA, ESCUDERO BROCAL ALICIA, CÁLIZ HERNÁNDEZ BETSABÉ, LLANOS GARCÍA MARÍA TERESA, MAYORGA BAJO ISABEL, FERNÁNDEZ PEÑA SILVIA, CAPILLA SANTAMARÍA ELENA, ARANGUREN OYARZÁBAL AINHOA, CALVO ALCÁNTARA MARÍA JOSÉ


Introduction: Elderly people living in nursing homes are one of the population groups most at risk of having a drug-drug interaction (DDI). The main aim of this study is to evaluate whether the pharmacist intervention reduces the prevalence of clinically relevant DDI (CRDDI). Secondary objectives are to assess the prevalence,
the factors related to intervention acceptance and its influence on health outcomes.

Method: A quasi-experimental, multicenter, transversal and prospective study with a before-after design was carried out in 13 nursing homes over a year. The Lexicomp® Lexi-interact™ database was used to identify DDI in all institutionalized people. Category D and X of DDI were classified as CRDDI and were susceptible to a pharmaceutical intervention. Monitoring interventions were computed as non-evaluable. The main endpoint was the number of DDI and the number of residents with CRDDI. Influence on health outcomes was investigated by
collecting the number of hospitalizations and emergency department (ED) visits combined and separately six months before and after the intervention.

Results: We found 3,882 CRDDI in 3,206 institutionalized people. 1,466 interventions were carried out in 744 residents. Excluding monitoring interventions, 217 of 676 were accepted (reduction of 32.1% in CRDDI and 27.4% in residents with CRDDI; p <0.001). Discontinuation and modification of the dosage regimen interventions were more accepted than those of switching drug. Residents in which there was acceptance of any recommendation had more mean hospitalizations and ED visits (0.69 ±1.269 vs. 0.4 ±0.849; p = 0.025) and were more polymedicated before the pharmacist’s intervention. A positive trend on health outcomes was shown but no statistical difference was achieved (–0.08 ±1.228 vs. 0.04 ±1.504; 95% CI: –0.159-0.413).

Discussion: Pharmacist intervention decreases by almost a third the prevalence of CRDDI and the number of residents with CRDDI in nursing homes although its influence on health outcomes could not have been confirmed.

DRUG INTERACTIONS – DRUG SAFETY – INTERDISCIPLINARY COMMUNICATION – NURSING HOMES – PHARMACEUTICAL SERVICES



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