OBJECTIVES: To evaluate the effect of pharmaceutical
care provided in addition to acute Geriatric Evaluation
and Management (GEM) care on the appropriateness of
prescribing.
DESIGN: Randomized, controlled trial, with the patient as
unit of randomization.
SETTING: Acute GEM unit.
PARTICIPANTS: Two hundred three patients aged 70 and
older.
INTERVENTION: Pharmaceutical care provided from
admission to discharge by a specialist clinical pharmacist
who had direct contacts with the GEM team and patients.
MEASUREMENTS: Appropriateness of prescribing on
admission, at discharge, and 3 months after discharge,
using the Medication Appropriateness Index (MAI), Beers
criteria, and Assessing Care of Vulnerable Elders (ACOVE)
underuse criteria and mortality, readmission, and emergency
visits up to 12 months after discharge.
RESULTS: Intervention patients were significantly more
likely than control patients to have an improvement in the
MAI and in the ACOVE underuse criteria from admission
to discharge (odds ratio (OR) 5 9.1, 95% confidence interval
(CI) 5 4.2–21.6 and OR 5 6.1, 95% CI 5 2.2–17.0,
respectively). The control and intervention groups
had comparable improvements in the Beers criteria.