Impact of an Interdisciplinary Team on
Pharmacotherapeutic Outcomes in a Geriatric Clinic
Sum Lam, Department of Clinical
Pharmacy, College of Pharmacy and Allied Health Professions, and
Christine M. Ruby
Abstract
Purpose: To determine if an
interdisciplinary team that includes a clinical pharmacist with
specialization in geriatrics improves prescribing appropriateness
and underutilization of cardiac medications among ambulatory
veterans.
Methods: Prescribing
appropriateness and underutilization of cardiac drugs among
ambulatory elderly veterans were evaluated. Medical records
of 25 new patients (initial visits 8/2002 - 2/2003) and 70
established patients (follow-up visits 9/2002 - 3/2003) were
retrospectively reviewed.
Results: All new patients
were male, mostly Caucasian (68%) with a mean age of 81.7 1.78
years. Each patient suffered from 5.6 3.0 chronic diseases
and took 6.4 2.5 medications concomitantly on a daily
basis. Each patient received medical care from a geriatric
interdisciplinary team at an outpatient clinic at an
university-affiliated Veterans Affairs medical center. After
the initial visit, prescribing appropriateness determined by
Medication Appropriateness Index (MAI) improved significantly from
11.1 5.9 to 3.6 2.8 (p < 0.0001) despite no significant
change in number of scheduled medications. Changes of
underutilization of angiotensin-converting-enzyme inhibitors
(ACEI), beta blockers (BB), and aspirin were -12%, -8%, and +12%,
respectively (all changes were not statistically
significant). Underutilization of warfar in remained
unchanged at 8%. Physician receptivity to clinical pharmacist
recommendations was 84% among new patients and 67% among
established patients.
Conclusion: An
interdisciplinary team improved prescribing appropriateness and
underutilization of ACEI and BB among ambulatory geriatric
patients. Clinical pharmacist initiated drug regimen review
improves pharmacotherapeutic outcomes in the elderly.