Effect of Inpatient Pharmaceutical Care Integrated with Electronic Prescription Screening in Elderly Patients with Chronic Kidney Disease at Phatthalung Hospital

Abstract

Background: Age-related declines in glomerular filtration rate and hepatic function reduce drug clearance in older adults. Elderly patients with chronic kidney disease, multimorbidity, and polypharmacy are at an increased risk of potentially inappropriate medication use (PIMs), ultimately leading to severe adverse drug events and acute kidney injury.

Objective: To evaluate the effects of inpatient pharmaceutical care integrated with electronic prescription screening in elderly patients with chronic kidney disease.

Methodology: This quasi-experimental study included elderly patients with chronic kidney disease, who were divided into a control group (n = 513) and an intervention group (n = 506). The intervention group received inpatient pharmaceutical care integrated with electronic prescription screening. The screening protocol was adapted from the American Geriatrics Society (AGS) Beers criteria and the screening tool of older persons' potentially inappropriate prescriptions/screening tool to alert to right treatment (STOPP/START) criteria. Data extracted from electronic medical records were analyzed using descriptive statistics, the Mann–Whitney U test, multiple logistic regression, the chi-square test, Fisher's exact test, McNemar test and the Wilcoxon signed-rank test.

Results: Inpatient pharmaceutical care integrated with electronic prescription screening significantly reduced the incidence of PIMs from 48.9 to 15.0 episodes per 1,000 patient-days (p-value < 0.001).

Conclusion: Inpatient pharmaceutical care integrated with electronic prescription screening effectively improved medication appropriateness in elderly patients with chronic kidney disease, thereby improving treatment safety and efficacy.