DRUG-RELATED PROBLEMS IN ELDERLY PATIENTS ADMITTED TO TAYSIDE HOSPITALS, METHODS FOR PREVENTION AND SUBSEQUENT REASSESSMENT

Introduction: although drug-related problems (DRPs) are known to be pr evalent in elderly patients, the literature on prevention of iatrogeni c disease is sparse. The present study addresses this requirement. Obj ectives: to assess the incidence of DRPs in elderly patients admitted to Tayside hospitals before (phase I) and after (phase II) implementat ion of preventive strategies. Design: all elderly people admitted to h ospital were screened by a pharmacist; individual case reviews were pr epared for all those with a potential DRP and reviewed by a three-memb er panel which made a final decision on the presence of a DRP and its contribution to admission. Setting: all hospital wards admitting elder ly patients in the Tayside region of Scotland. Subjects: 1011 elderly patient admissions over a 9-month period (phase I); 857 elderly patien t admissions over an 8-month period (phase II). Main outcome measures: incidence of DRPs before and after targeted intervention strategies ( information bulletin for general practitioners, patient information le aflet, oral presentation to trainee general practitioners). Results: i n phase I, the incidence of DRPs was 144/1011 (14.2%), with 54/1011 (5 .3%) of the admissions identified as being definitely or probably drug -related. Non-steroidal anti-inflammatory drugs (NSAIDs) were the main drug group involved, being responsible for 15/54 (28%) of admissions primarily due to a DRP. Over 66% of admissions due to adverse effects of NSAIDs were considered to be definitely preventable. In phase II, a fter targeted intervention strategies, there was no significant reduct ion in total incidence of DRPs or incidence of DRPs related to NSAIDs. However, there appeared to be an improvement in the first 4 months, a nd a significant drop in NSAID prescribing in Tayside compared with th e rest of Scotland was observed. Conclusion: DRPs remain a significant problem in elderly patients and NSAIDs are the major contributor. The intervention strategies used in the study were not demonstrably effec tive, but a continuous programme of education may be necessary to limi t NSAID use.