Drug-related problems in geriatric rehabilitation patients after discharge - A prevalence analysis and clinical case scenario-based pilot study.

Background: Geriatric patients bear a high risk for having drug-related problems (DRPs). Transitions of care are especially susceptible to these DRPs. Objective: To highlight the prevalence of DRPs in geriatric patients' post-discharge medication lists and to assess physicians' ability to identify DRPs by using clinical case scenarios. Methods: A sequential prospective mixed-method study was performed. In a DRP prevalence analysis, an expert panel of clinical pharmacists analyzed DRPs in post-discharge medication lists of long-term hospitalized patients from a German inpatient geriatric rehabilitation center. Based on these results, the expert panel created two clinical case scenarios with applicable medication history. The cases were reflective of the most commonly identified DRPs. They were provided to hospital physicians and general practitioners (GPs) for assessment. Physicians were asked whether they approve the prescriptions in the clinical case scenarios. If a physician had not identified a prescription containing a defined DRP, the clinical pharmacist then provided drug information about it. With this, physicians' ability to identify DRPs and their response to a theoretical intervention was assessed. Results: DRP prevalence analysis: A total of 639 prescriptions were analyzed from 63 enrolled patients of whom 52 (83%) were affected by at least one DRP. Twenty-eight hospital physicians and 26 GPs have been assessed. They identified 172 (46%) from 378 possible DRPs (seven DRPs multiplied by 54 physicians). For unidentified DRPs, physicians received tailored drug information and the number of identified DRPs rose to 298 (79%). Conclusions: A clear majority of patients were affected by DRPs. However, the results from the following pilot study confirm that many DRPs at care transitions can be reduced by providing applicable medication history and drug information. This intervention can be done by clinical pharmacists as part of the multidisciplinary care team in routine care. Synopsis: Geriatric patients bear a high risk for having drug-related problems (DRPs). Strategies to protect them are needed, especially during transitions of care due to information and knowledge gaps. Therefore a sequential prospective mixed method study was performed. Initial post-discharge medication lists of geriatric patients were analyzed for DRPs with 83% of patients being affected. Afterwards, physicians' ability to identify DRPs was assessed based on clinical case scenarios. These clinical case scenarios included an applicable medication history and tailored drug information was provided. Under these conditions, physicians identified many of the defined DRPs. (C) 2017 Elsevier Inc. All rights reserved.