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Pharmacy Practice (Granada)

On-line version ISSN 1886-3655Print version ISSN 1885-642X

Abstract

GAUCI, Marise; WIRTH, Francesca; AZZOPARDI, Lilian M  and  SERRACINO-INGLOTT, Anthony. Clinical pharmacist implementation of a medication assessment tool for long-term management of atrial fibrillation in older persons. Pharmacy Pract (Granada) [online]. 2019, vol.17, n.1, 1349.  Epub Nov 11, 2019. ISSN 1886-3655.  https://dx.doi.org/10.18549/pharmpract.2019.1.1349.

Background:

Optimisation of drug therapy is important in the older population and may be facilitated by medication assessment tools (MATs).

Objective:

The purpose of the study was to evaluate whether appropriateness of drug therapy and clinical pharmacist intervention documentation improved following implementation of a previously developed MAT for the long-term management of atrial fibrillation (MAT-AF).

Methods:

Adherence to MAT-AF review criteria and clinical pharmacist intervention documentation was assessed by the researcher pre-MAT implementation in 150 patients aged ≥60 years admitted to a rehabilitation hospital with a diagnosis of atrial fibrillation. MAT-AF was introduced as a clinical tool in the hospital for identification of pharmaceutical care issues in atrial fibrillation patients. Adherence to MAT-AF and pharmacist intervention documentation were assessed by the researcher post-MAT implementation for a further 150 patients with the same inclusion criteria. Logistic regression analysis and measurement of odds ratio was used to identify differences in adherence to MAT-AF pre- and post-MAT implementation. The differences between two population proportions z-test was used to compare pharmacist intervention documentation pre- and post-MAT implementation.

Results:

Adherence to MAT-AF criteria increased from 70.9% pre-implementation to 89.6% post-implementation. MAT-AF implementation resulted in a significant improvement in prescription of anticoagulant therapy (OR 4.07, p<0.001) and monitoring of laboratory parameters for digoxin (OR 10.40, p<0.001). Clinical pharmacist intervention documentation improved significantly post-implementation of MAT-AF (z-score 20.249, p<0.001).

Conclusions:

Implementation of MAT-AF within an interdisciplinary health care team significantly improved the appropriateness of drug therapy and pharmacist intervention documentation in older patients with atrial fibrillation.

Keywords : Atrial Fibrillation; Disease Management; Drug Utilization Review; Medication Therapy Management; Inappropriate Prescribing; Pharmaceutical Services; Pharmacists; Aged; Clinical Audit; Malta.

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