Survey on the Actual Situation and Effectiveness of Pharmacists’ Proposals for Drug Reduction Based on Polypharmacy Conferences in an Acute Care Hospital for the Elderly

Abstract

We investigated drug reduction suggestions by pharmacists based on a multidisciplinary polypharmacy conference in an acute care hospital for the elderly and the adoption rate of such suggestions. The target patients were 587 admitted to the Orthopedics and Regional Comprehensive Care Ward, Tokyo Metropolitan Institute for Geriatrics and Gerontology. The number of medications taken at the time of discharge from the hospital was significantly lower in the cases in which the pharmacist suggested medication reduction compared to those at the conference, respectively (P < 0.05). In addition, 83.4% of the proposals from pharmacists were adopted. The common reasons given for the proposal were “improvement of symptoms” (92.4%) and “adherence-related” (84.8%). High adoption rates were observed for anti-inflammatory analgesics (91.7%) and gastrointestinal drugs (83.2%). The group that adopted drug reduction suggestions exhibited 1.1 fewer medications and a reduction of 0.4 in the daily dose count at discharge compared to the time of the conference (P < 0.001). Logistic regression analysis revealed that being a woman, DASC-21 ≤ 29, being on 11 or more medications upon admission, and having a period of 12 or more days from the conference to discharge were factors independently associated with adoption. Drug reduction proposals from pharmacists are more likely to gain physician acceptance if they rely on patient-verified information about symptom changes and medication compliance. These findings suggest that drug reduction interventions are effective for patients without cognitive decline, who have a high number of medications at admission, and can afford a follow-up period.