Aims
The aims of this study were to describe the rate of prescribing changes for older aged patients occurring as part of routine care in a Geriatric Evaluation and Management (GEM) unit setting, and identify reasons why enhanced prescribing opportunities suggested by pharmacist reviews were accepted or rejected by doctors.
Methods
A retrospective cross-sectional observational study of patients aged ≥65 years admitted to the GEM units at a metropolitan Victorian health network from 1 January 2023 to 31 March 2023 was conducted. Data was collected for baseline characteristics and medication prescribing and reviews documentation over three time points (admission to acute care, admission to GEM and discharge from GEM).
Results
Between admission to discharge from GEM, the mean number of total medications decreased by 1.0 (p < 0.05). There was no significant change in number of regular medications (p=0.61), PIMs (p=0.70) or DBI (p=0.25). Pharmacists initiated an average of 4.5 medication reviews per patient, with 62.2% of pharmacist recommendations accepted by the medical team. 26.7% of pharmacist recommendations were rejected without further documentation. The most common reasons for accepted changes were for medications no longer indicated (27.8%) and incorrectly charted (22.4%).
Conclusion
GEM admission was associated with reduced overall medication prescriptions but not high-risk prescriptions. Pharmacists within the GEM unit play an important role in improving prescribing appropriateness and safety. Future studies are required to identify whether structured de-prescribing frameworks within the GEM setting improves medication safety of older people transitioning from hospital care.