Drug-related problems (DRPs), which include potentially inappropriate medication (PIM), medication errors (MEs) and adverse drug events (ADEs), represent a major and avoidable health problem.(1)
DRPs are considered the most prevalent iatrogenic issue worldwide, especially in frail patients. There is strong evidence that DRP morbidity is a major avoidable health problem.(2)
Approximately 38% of emergency department visits are associated with a DRP, of which more than 70% are considered avoidable(3, 4). Furthermore, DRPs are responsible for 5–10% of hospital admissions and 21% of readmissions(5).
Age, polymedication, comorbidities, anticoagulant use and cognitive impairment have been identified as the main risk factors for DRP, all of which place the population over 65 years of age at high risk of DRP(6)
In qualitative terms, polymedication is understood as taking more drugs than clinically appropriate, while quantitative criteria set a limit on the number of drugs used.
In quantitative terms, polymedication is usually defined as taking five or more drugs continuously, although from ten or more prescribed drugs upward, the associated risks are higher and therefore patients require special care(7, 8)A number of studies have associated the probability of adverse events with the number of drugs being taken: this probability is 6% when a patient takes two drugs, 50% when a patient takes five drugs, and almost 100% when a patient takes eight or more drugs (9)
A recent study related polymedication to the risk of falls, with the prevalence being twice as high in patients taking 10 or more drugs, and the risk being at its greatest in the case of antipsychotics and sedative-hypnotics(10).
Residents in care homes consume four times more drugs than the equivalent population living in the community(11). Multiple drugs are often prescribed because practitioners uncritically follow clinical practice guidelines and do not tailor therapeutic recommendations to the benefit-risk profile of the individual patient(12)
This is why DRPs are especially prevalent in the care home setting, particularly PIM(13). Potentially inappropriate medication is understood as a prescription where the risks of suffering a DRP outweigh the benefits, particularly when there are safer alternatives for the prescription(14) Approximately 40% of prescriptions in care homes may be inappropriate(13). Various studies have shown that between 15–50% of residents are subject to PIM with an average of between 2.2 and 4 DRPs per patient(15)
Vink et al (16) found that pharmacists were able to identify DRPs that other professionals could not. Most DRPs involve suboptimal therapies or unnecessary medication(17)
A comprehensive medication review is understood as a patient-centred approach for optimising medication use and improving patient health outcomes by ensuring that the medication the patient receives is appropriate, effective and safe for the patient and their current condition (18).
In recent years, medication review programmes led by primary care pharmacists have become established in care homes. Medication review in a multidisciplinary team setting (doctors, nurses and pharmacist) has been successful in reducing both costs and iatrogenic risks, although the results are quite variable and often difficult to interpret. A recent meta-analysis suggests that de-prescription programmes in care homes led by primary care pharmacists in multidisciplinary teams reduce PIM by 59%(19). Another meta-analysis of pharmaceutical interventions in care homes demonstrated a 43.8% reduction in the incidence of falls(20)
The Interdepartmental Plan for Social and Health Care and Interaction(21) has been developed
in accordance with the principles of the National Strategy for Primary Care and Community Health 2016–2020(22) It focuses on the need to provide comprehensive and integrated healthcare to people living in care homes. This plan proposes a model of efficient pharmaceutical care that ensures safety and improves the quality of life and health outcomes of people living in care homes. A specific goal is to integrate pharmacists into multidisciplinary healthcare teams. As part of the Department of Health's Programme for prevention and chronic care(23), the Guide for the Basic Management of Medication in Chronic Patients: Conciliation, Review, De-prescription and Adherence(24) has been published, in which a method for optimising pharmacological treatments is established via the implementation of multidisciplinary patient-centred medication review procedures.
In 2022, the Camp de Tarragona Primary Care Directorate of the Catalan Health Institute (Institut Català de la Salut) had 24 nursing homes attached to 20 primary care teams, with a total of 1928 residents. Within the regulatory framework described above, a project on pharmaceutical care for patients admitted to care homes was initiated with the aim of reducing PIM, thereby improving patient safety in relation to DRPs.
The hypothesis of this study is that this pharmaceutical intervention led by a primary care pharmacist and based on systematically reviewing the pharmacotherapeutic plans of patients admitted to care homes will effectively improve the quality and safety of treatment plans.