Efetividade de intervenções farmacêuticas na omissão de prescrição e desprescrição de medicamentos em pacientes hospitalizados: estudo INFAR

Abstract

The presence of multimorbidities is common among older people, which make them one of the biggest medication consumers. Potentially inappropriate prescriptions for older people became a global concern, to achieve adequate pharmacotherapy it is fundamental knowing effectiveness and safety of all medications and the risk-benefit ratio favor the patient.Objectives: This study aimed to assess the effectiveness of pharmacist interventions to reduce the omission of evidence‐based cardiovascular medication, as well as polypharmacy and promote the deprescribing of potentially inappropriate medications in hospitalised older patients diagnosed with cardiovascular diseases. Methods: This before‐and‐after study was conducted among patients aged ≥ 60 years (n = 319) at a cardiovascular hospital in Brazil. Pharmacists conducted medication reviews for these patients. The first prescription on hospital admission and that at discharge were collected and compared for prescribing omission, polypharmacy, and prescribing of potentially inappropriate medications. Results: The mean patient age was 68.9 (±6.2) years. The mean incidences of prescribing potentially inappropriate medications and omissions decreased from 0.90 at admission to 0.10 at discharge (p < 0.001) and from 0.65 to 0.30 (p < 0.001), respectively. The number of potentially inappropriate medications prescribed decreased significantly, from 291 at admission to 28 at discharge, reflecting a 90% reduction. Additionally, the mean number of medications prescribed decreased from 9.8 to 6.5 (p < 0.001). Specifically, the percentage of patients with a high anticholinergic burden decreased from 40.4% at admission to 22.6% at discharge. The mean anticholinergic burden score decreased from 2.34 (±1.36) at admission to 1.82 (±1.26) at discharge (p<0.001).Conclusion: This study emphasizes the role of medication reviews by clinical pharmacists in reducing polypharmacy, prescribing omissions, and inappropriate prescribing, including the anticholinergic burden, in older adults with cardiovascular diseases. It demonstrates that targeted pharmacist-led interventions improve medication safety and promote safer prescribing practices during hospitalization.