4CPS-144 Optimising medications in geriatric patients: insights from the aspire randomised controlled trial on pharmacist-led medication reviews

<h3>Background and Importance</h3> High-risk geriatric inpatients often face a complex balance between medication benefits and potential harms. The ASPIRE randomised controlled trial (RCT) aimed to assess the effectiveness of a pharmacist-led intervention in reducing unplanned hospital admissions through comprehensive medication management. <h3>Aim and Objectives</h3> This study aims to analyse recommendations from medication reviews as process outcomes and evaluate the duration of the intervention. <h3>Material and Methods</h3> The intervention included medication reconciliation at both admission and discharge, medication review, telephone contact with primary care, patient counselling and a follow-up call post-discharge. We analysed the number and types of recommendations, their acceptance rate, Anatomical Therapeutic Chemical Classification (ATC), and time required for the intervention. <h3>Results</h3> Between February 2021 and March 2024, 825 patients (mean age 86.3 (Standard deviation (SD) 5.9) years; 59.6% female) were recruited, with 415 in the intervention group. We conducted 414 reviews, resulting in 1,160 total recommendations. Hospital pharmacists made at least one recommendation for 380 patients (91.6%), averaging 3.1 (SD 1.7) recommendations per patient. The acceptance rate was 89.7%, with 843 (72.7%) recommendations immediately implemented and 198 (17.0%) documented for future action. The three most common recommendations were medication <b>discontinuation</b> (415 (35.8%), <b>initiation</b> (237 (20.4%)) and <b>dose change</b> (155 (13.4%)). Within these recommendations, the Alimentary tract and Metabolism classes accounted for the highest number of medications (268 (33.2%)), followed by the Nervous system (176 (21.8%)) and the Cardiovascular system (145 (18.0%)). The total mean duration of the intervention was 1 hour 26 minutes. Medication reconciliation at admission took an average of 11.1 (SD 7.1) minutes, while discharge reconciliation averaged at 9.4 (SD 6.5) minutes. Medication review required 30.8 (SD 16.1) minutes, and telephone contact with health professionals 9.0 (SD 6.9) minutes. Patient counselling lasted 20.0 (SD 10.3) minutes and follow-up calls averaged 5.9 (SD 4.4) minutes. <h3>Conclusion and Relevance</h3> In this multifaceted intervention trial hospital pharmacists provided approximately three medication related recommendations upon discharge, with a high implementation agreement rate, indicating strong acceptability by physicians. The ATC categories confirm the relevant focus of medication review for geriatric patients. Reporting intervention duration is valuable for future applications in various settings. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest