Impact of an Interdisciplinary Team on Pharmacotherapeutic Outcomes in a Geriatric Clinic
Sum Lam, Department of Clinical Pharmacy, College of Pharmacy and Health Sciences, and Christine M. Ruby
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.
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.
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.
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.