Clinical pharmacist interventions in cardiovascular disease pharmacotherapy in elderly patients on excessive polypharmacy : A retrospective pre-post observational multicentric study.

ABSTRACT

BACKGROUND: Cardiovascular diseases (CVD) are often treated with excessive polypharmacy (10 or more medications) in primary care, and these patients are mostly excluded from trials. Collaborative care, including clinical pharmacists (CP), is one of the possible approaches to address these problems; however, it has not been studied yet in this part of Europe. Hence, the main aim of the study was to determine how CP interventions in a medical review form (MR) can have an impact on the pharmacotherapy in patients on excessive polypharmacy with CVD (number of medications, potential drug-drug interactions of type X-pXDDI, potentially inappropriate medications in the elderly-PIM and treatment guidelines adherence). METHODS: This retrospective, observational pre-post multicentric study included elderly patients with CVDs aged 65 years or above, treated with 10 or more medications concomitantly (excessive polypharmacy) in Slovenian primary care (2012-2014). The MR provided by CPs included drug-related problems and potential pXDDIs, as well as PIMs. The pXDDIs were determined with Lexicomp Online. The German Priscus lists was used to determine PIMs. A binary logistic regression model was chosen to examine the influence of independent variables on the dependent variable (treatment guidelines adherence). RESULTS: In this study 243 patients were included and 980 interventions were proposed in the MR form of which 479 (48.9%) were accepted by the general practitioners (GP). The CPs proposed 320 interventions in CVDs treatment, of which 140 were accepted by the GPs (43.8%). The acceptance of the CPs' recommendations reduced the number of medications by 7.3% (from 13.1 to 12.1 per patient; p < 0.05), the number of pXDDIs by 47.8% (from 40 to 12 patients; p < 0.05), the total of prescribed PIMs by 26.6% (p = 0.752) and adherence to arterial hypertension treatment guidelines was improved (p < 0.05). CONCLUSION: CPs' interventions significantly improved the quality of pharmacotherapy prescribing by reducing the total number of medications and pXDDIs and led to better hypertension treatment guidelines adherence.