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A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older, HIV-Positive Patients.

A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older, HIV-Positive Patients.
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McNicholl IR, Gandhi M, Hare CB, Greene M, Pierluissi E,


McNicholl IR, Gandhi M, Hare CB, Greene M, Pierluissi E, (click to view)

McNicholl IR, Gandhi M, Hare CB, Greene M, Pierluissi E,

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Pharmacotherapy 2017 10 10() doi 10.1002/phar.2043

Abstract
OBJECTIVE
The goal of this pharmacist-led study was to utilize 2 validated instruments, Beers and Screening Tool of Older Persons’ Potentially inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions.

DESIGN
Prospective, randomized, interventional trial.

SETTING
Large urban clinic providing interdisciplinary primary and HIV care for approximately 2700 HIV-positive, publically insured patients.

DATA SOURCE
Computerized electronic record search was conducted for all patients who met the 2 search criteria: 50 years and older and a primary care appointment within the last 12 months.

PATIENTS
After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed.

MEASUREMENTS AND MAIN RESULTS
Patients had a mean age of 58 years, 71% male, 44% Caucasian, and a mean CD4 count of 536 cells/mm(3) . Common co-morbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%) and diabetes (22%). Patients sampled were prescribed a mean of 11.6 ± 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. Potentially inappropriate prescribing was identified in 54% and 63% of patients using the STOPP and Beers criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least 1 medication discontinued with almost 10% having 6 or more medications discontinued. More than 40% of patients had at least 1 Beers or STOPP criteria that required immediate correction by the pharmacist.

CONCLUSIONS
Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing employing Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention. This article is protected by copyright. All rights reserved.

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