Application of a prescribing indicators tool to assist in identifying drug-related problems in a cohort of older Australians Benjamin J. Basger, Timothy F. Chen and Rebekah J. Moles Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia Keywords decision support tool; drug-related problems; inappropriate drug use; older patients; under-treatment Correspondence Mr Benjamin J. Basger, Faculty of Pharmacy, The University of Sydney, A15 Science Road, Sydney, NSW 2006, Australia. E-mail: ben.basger@sydney.edu.au Received May 12, 2011 Accepted September 23, 2011 doi: 10.1111/j.2042-7174.2011.00177.x Abstract Objective Drug-related problems (DRPs) are common in older people, resulting in a disproportionate number of serious medication adverse events. Pharmacist-led interventions have been shown to be effective in identifying and reducing DRPs such as medication interactions, omission of recommended medications and use of inef- fective medications. In 2008 we proposed a prescribing indicators tool to assist in identifying DRPs as part of the Australian medication review process. The objective was to apply the proposed prescribing indicators tool to a cohort of older Austra- lians, to assess its use in detecting potential DRPs. Methods The prescribing indicators tool was applied in a cross-sectional observa- tional study to 126 older (aged 65 years) English-speaking Australians taking five or more medications, as they were being discharged from a small private hospital into the community. Indicators were unmet when prescribing did not adhere to indicator tool guidelines. Key findings We found a high incidence of under-treatment, and use of inappro- priate medications. There were on average 18 applicable indicators per patient, with each patient having on average seven unmet indicators. Conclusion The use of a prescribing indicators tool for commonly used medica- tions and common medical conditions in older Australians may contribute to the efficient identification of DRPs. Introduction Medication management in older people (65 years old) remains less than optimal. [1–6] Drug-related problems (DRPs), which can be defined as events involving medication therapy that actually or potentially interfere with health out- comes, [7] have been commonly identified in older people, [8–12] resulting in disproportionately high numbers of serious adverse medication events. [4] Methods to identify and reduce DRPs have been reviewed, [13–17] and include the use of medication assessment tools such as the Beers Criteria, [18] STOPP/START [19] and tools developed in Germany [20] and France; [21] educational inter- ventions; [14] comprehensive geriatric assessment; [22] discon- tinuation of multiple medications; [23] and electronic health record clinical decision support. [24,25] Pharmacist-led interventions have been shown to be among the most effective methods used to improve prescrib- ing quality in older patients. [14,16,17] Pharmacists have been shown to be able to identify and reduce DRPs of clinical significance when their recommendations are accepted by medical practitioners. [8,9,16,26–32] In Australia, pharmacists accredited to perform medication reviews through post- graduate study systematically evaluate a patient’s pharmaco- therapeutic needs and drug regimen, at the request of the patient’s medical practitioner. They conduct a consumer interview, document findings, and provide and discuss management recommendations to optimize therapy with the medical practitioner. This has been shown to result in approximately 70% of their recommendations being accepted, with 42–58% of these recommendations imple- mented. [11,32] The majority of these recommendations have been shown to be consistent with evidence-based Australian medication information sources. [1,33] International Journal of Pharmacy Practice International Journal of Pharmacy Practice 2012, 20, pp. 172–182 Research Paper © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society International Journal of Pharmacy Practice 2012, 20, pp. 172–182 Downloaded from https://academic.oup.com/ijpp/article/20/3/172/6102283 by guest on 05 June 2022