Fifth Annual Grant Winners 2004-2005

Deborah H. Kennedy, Pharm.D., HPD - College of Pharmacy
Ceressa T. Ward, Pharm.D., HPD - College of Pharmacy
Brent Salvig, Pharm.D., West Palm Beach Veterans Affairs Medical Center
Timothy Kelley, MSW, West Palm Beach Veterans Affairs Medical Center
Shashi Bhandari-Gadson, ARNP, West Palm Beach Veterans Affairs Medical Center

Wallace Marsh, Ph.D., HPD - College of Pharmacy
Christine M. Ruby, Pharm.D., BCPS, Duke University Division of Geriatric Medicine Durham Veterans Affairs Medical Center

Dean William Hardigan, HPD – College of Pharmacy

Title: Impact of a Clinical Pharmacist on Medication Appropriateness for Elderly Veterans Residing in Assisted Living Facilities

Abstract:

The primary objective of this research study is to demonstrate that clinical pharmacist review of medication therapy improves medication prescribing. Secondary objectives are to determine changes in adverse drug events and/or healthcare resource utilization for elderly veterans residing in Assisted Living Facilities (ALFs) after a clinical pharmacist intervention. The literature has assessed medication appropriateness and the impact of a clinical pharmacist for elderly residing in community and inpatient settings. There is very little literature describing medication appropriateness and there are no studies documenting the impact of a clinical pharmacist in the ALF environment. This research will provide new information about clinical pharmacists’ impact in ALFs.

One-hundred and two patients greater than 65 years old residing in ALFs and cared for by the Community Residential Care (CRC) team will be randomly selected for inclusion. Before randomization, a retrospective chart review will be conducted to determine a baseline Medication Appropriateness Index (MAI) score and develop written pharmacotherapy recommendations. Only patients randomized to clinical pharmacist intervention will have their written pharmacotherapy recommendations forwarded to their Primary Care provider and have a clinical pharmacist join the CRC team to address all medication-related issues during the 6 month intervention period. After 6 months or close-out, another MAI score, adverse drug events, and healthcare resource utilization (emergency room visits, unscheduled hospital admissions and/or unscheduled outpatient clinic visits) will be recorded.

Descriptive statistics will be reported for all continuous variables. Differences between groups at baseline will be determined using the Student’s t-test for continuous data and the Chi-square test for nominal data. Differences between MAI scores at baseline and follow-up for each group and between groups, adverse drug events, and healthcare resource utilization between the groups and the association between MAI score and healthcare utilization will be determined using appropriate regression, ANOVA, and ANCOVA techniques.