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Objective Evaluate the clinical, economic, and organizational impact of pharmaceutical interventions performed during medication review in a cognitive-behavioral unit. Setting Study conducted in a cognitive-behavioral unit with retrospective data from January 2011 to june 2017. Methods This study was conducted from retrospective data of medication review in a cognitive-behavioral unit. During medication review, pharmacists identified relevant drug related problems lead to a pharmaceutical intervention which is submitted to the physician. All pharmaceutical interventions carried out from January 2011 to june 2017 were retrospectively analyzed to evaluate their clinical, economic and organizational impact using a multidimensional tool. Main outcome measure CLinical, Economic and Organizational impact using the CLEO tool. Results During the study period, 543 drug related problems and pharmaceutical interventions were recorded for patients hospitalized in the cognitive-behavioral unit (79.0 ± 9.5 years, 59% female). The most common types of drug related problems identified were ‘non conformity to guidelines / contra-indication’ (28.7%), ‘drug without indication’ (21.7%), and ‘improper administration’ (15.1%). The majority of pharmaceutical interventions were considered to have at least a clinical significant impact from the pharmacist’s perspective (74%). Regarding the economic and organizational dimensions, 55.2% of pharmaceutical interventions would decrease the costs of care and 35.9% of pharmaceutical interventions would be favorable on the quality of care process. Conclusions The present study shows that the pharmacist may detect a high number of drug related problems with significant clinical relevance during medication review in a cognitive-behavioral unit. Describing and identifying significant pharmaceutical interventions in cognitive-behavioral unit patients allow us to better understand and improve clinical practice in this population.

Background There are several assessment scales to evaluate the risk of falls or the adverse drug reaction risk. Few are sufficiently specific to assess the impact of drug prescriptions on falls in geriatric populations. Objective To define the risk of anticholinergic and sedation-related ADRs in an elderly hospitalized patient population using the Drug Burden Index (DBI), Anticholinergic Drug Scale (ADS), and Sedative Load Model (SLM). Setting Five geriatric university hospital centers in France. Method Multicenter prospective cohort study from 2011 to 2013. Drug prescriptions were compiled to estimate anticholinergic and sedative exposure. Any associations between the drug scales and falls were assessed. Main outcome measure Drug exposure estimated with the DBI, ADS, and SLM scales. Results 315 patients, with a mean age of 87 years and 117 documented falls, were included from 5 geriatric hospitals. Sixty-one percent of these patients had a DBI > 0, 20.3% had an ADS ≥ 3, 56.2% a SLM > 0. No association was detected between the scores and the risk of a fall (p > 0.05). Factors significantly associated with a risk of a fall were: a prior history of a fall in the previous 12 months (adjusted odds ratio [aOR] = 7.24, 4.06-12.89), orthostatic hypotension ([aOR] = 2.84; 1.39-5.79), or prescription of antidepressants ([aOR] = 2.12; 1.17-3.84). Conclusion A specific scale to identify high-risk prescriptions would help clinicians and pharmacists to optimize therapeutic treatments for the elderly. In light of the multifactorial characteristics of falls, predicting their risk should be based on a well-defined set of factors.

Objective To investigate the association between the medication exposure, measured by the polypharmacy/excessive polypharmacy and the anticholinergic and/or sedative drug exposure, on frailty status among French older community-dwelling patients. Setting day-care unit in France (Lyon), with retrospective data from July, 2017 to March, 2018. Method This monocentric cross-sectional study included community-dwelling patients aged 65 years and over and admitted at the day-care unit for a geriatric evaluation. Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and excessive polypharmacy were defined as the concomitant use of 5–9 and 10 or more drugs, respectively. The cumulative anticholinergic and sedative exposure was measured using the drug burden index (DBI). The DBI score was presented in 4 differentiated scores: a null score (DBI = 0), a combined score (anticholinergic and sedative score), an anticholinergic score, and a sedative score. The association between medication and frailty was assessed by logistic regression models controlled for multiple potential confounders. Main outcome measure Association between medication exposure (polypharmacy, anticholinergic and sedative exposure) and frailty. Results In this study, 403 patients were included: 44.7% were frail and 40.7% were pre-frail. Polypharmacy and excessive polypharmacy affected 44.7% and 17.1% of the population respectively. The mean DBI was 0.33 ± 0.43, with 16.4% of patients with only sedative exposure, 9.7% with only anticholinergic exposure and 33.0% with both exposures. After adjustment, polypharmacy and excessive polypharmacy were associated with frailty with adjusted odds ratios (95% confidence interval) of 2.18 (1.03–4.22) and 2.72 (1.01–7.37) respectively. The cumulative exposure to anticholinergic and sedative drugs (combined score) was significantly associated to an increased risk for frailty with adjusted odds ratios (95% confidence interval) of 3.54 (1.47–8.57). Conclusion The study showed that polypharmacy and cumulative anticholinergic and sedative exposure are associated with frailty. Further research should address the potential benefit of collaborative medication review for preventing medication-associated frailty.