Apoorva Ramesh
Independent Researcher
Karnataka, India
Abstract
Polypharmacy, the concurrent use of multiple medications, is a prevalent concern among the elderly population due to the high risk of adverse drug events (ADEs), drug interactions, and medication non-adherence. This manuscript investigates the effectiveness of pharmacist-led medication reconciliation as an intervention to mitigate the risks associated with polypharmacy in elderly care settings. By integrating pharmacists into care teams during transitional care points—particularly hospital admissions and discharges—discrepancies in medication regimens can be identified, corrected, and optimized for safety and efficacy. This study provides a comprehensive analysis of the impact of such interventions on medication safety, patient outcomes, and healthcare utilization. It draws on real-world evidence from observational studies and clinical trials, supported by a structured methodology that includes a mixed-methods approach to data collection and analysis. Findings demonstrate significant reductions in medication errors, inappropriate prescriptions, and hospital readmission rates when pharmacists lead medication reconciliation. The study concludes by recommending the institutionalization of pharmacist-led reviews within elderly care workflows to enhance therapeutic outcomes and reduce healthcare burdens.
Keywords
Polypharmacy, Elderly Care, Medication Reconciliation, Clinical Pharmacist, Drug Interactions, Adverse Drug Events, Transitional Care, Medication Safety, Pharmacovigilance, Interprofessional Collaboration
References
- Boockvar, K. S., Carlson Lacorte, H., Giambanco, V., Fridman, B., & Siu, A. (2006). Medication reconciliation for reducing drug-discrepancy adverse events. American Journal of Geriatric Pharmacotherapy, 4(3), 236–243.
- Gillespie, U., Alassaad, A., Hammarlund-Udenaes, M., Hedstrom, M., Bondesson, A., & Peterson, C. (2009). Effects of pharmacists’ interventions on appropriateness of prescribing and evaluation of the instruments’ (MAI, STOPP and STARTs) abilities to predict hospitalization. PLoS ONE, 4(12), e8456.
- Kwan, J. L., Lo, L., Sampson, M., & Shojania, K. G. (2013). Medication reconciliation during transitions of care as a patient safety strategy. Annals of Internal Medicine, 158(5_Part_2), 397–403.
- Mueller, S. K., Sponsler, K. C., Kripalani, S., & Schnipper, J. L. (2012). Hospital-based medication reconciliation practices: A systematic review. Archives of Internal Medicine, 172(14), 1057–1069.
- Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K., & Bates, D. W. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Annals of Internal Medicine, 138(3), 161–167.
- Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1), 57–65.
- Spinewine, A., Schmader, K. E., Barber, N., Hughes, C., Lapane, K. L., Swine, C., & Hanlon, J. T. (2007). Appropriate prescribing in elderly people: How well can it be measured and optimized? Lancet, 370(9582), 173–184.
- Varkey, P., Cunningham, J., & O’Meara, J. (2007). Multidisciplinary approach to medication reconciliation in inpatient setting. Mayo Clinic Proceedings, 82(8), 749–755.
- Tjia, J., Bonner, A., Briesacher, B. A., McGee, S., Terrill, E., Miller, K., & Lapane, K. L. (2009). Medication discrepancies upon hospital to skilled nursing facility transitions. Journal of General Internal Medicine, 24(5), 630–635.
- Onder, G., van der Cammen, T. J. M., Petrovic, M., & Somers, A. (2013). Strategies to reduce the risk of iatrogenic illness in complex older adults. Age and Ageing, 42(3), 284–291.