5PSQ-003 Impact of pharmacist interventions in elderly patients with polypharmacy

<h3>Background and Importance</h3> Polypharmacy in elderly people is a growing concern, impacting patient safety and healthcare costs. Pharmacists play a key role in reviewing medication regimens for these patients, enabling the optimisation of pharmacotherapy, reducing adverse effects, and promoting adherence. <h3>Aim and Objectives</h3> To assess the clinical, economic and organisational impacts of pharmacist interventions in elderly patients with excessive polypharmacy (≥10 medications) at discharge. <h3>Material and Methods</h3> A protocol was established at a tertiary hospital for the review of polymedicated patients over 80 years of age on 10 or more chronic drugs, who were admitted to the internal medicine service from 1 March to 1 July 2024. Pharmacists provided recommendations to the internist for optimising therapy at discharge. Interventions were classified into seven categories: addition of a new drug, drug discontinuation, drug switch, dose adjustment, change of administration route, drug monitoring and administration modality optimisation. The CLEO (Clinical, Economic and Organisational) tool assessed the impact of these interventions. Clinical impact was scored using six levels from −1 to 4 (negative, null, minor, moderate, major and avoiding a fatality) and the economic and organisational dimensions had three levels (negative, null, positive) scored −1, 0, 1, respectively. <h3>Results</h3> Thirty-eight patients were reviewed, with a mean age of 86.8 years (SD: 4.17), 59.0% were women. In total, 101 interventions were made, medium of 2.7 (SD: 1.4) per patient. The most frequent intervention was drug discontinuation (55.4%), followed by dose adjustments (23.8%), drug monitoring (8.9%), drug switches (7.9%), administration optimisation (3.0%), and new drug additions (1.0%). The economic impact was positive in 85.1%, and negative in 4.0% of interventions. Most interventions (70.3%) had no organisational impact but no negative impact either. The clinical impact was mostly minor (54.5%). There was no negative clinical impact, and in 15% of interventions the Clinical impact was major or avoided a fatality. <h3>Conclusion and Relevance</h3> Pharmacist interventions in polypharmacy are essential to reduce healthcare costs and improve care quality. Expanding this practice to other hospitals is recommended. <h3>References and/or Acknowledgements</h3> Vo HT, <i>et al</i>. CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions. <i>Eur J Hosp Pharm</i>. 2021;<b>28</b>(4):193–200. doi: 10.1136/ejhpharm-2020-002642. https://ejhp.bmj.com/content/28/4/193 <h3>Conflict of Interest</h3> No conflict of interest