Clinical pharmacist implementation of a medication assessment tool for long-term management of atrial fibrillation in older persons

• Published in: Pharmacy practice Vol. 17; no. 1; p. 1349
• Main Authors: Gauci, Marise, Wirth, Francesca, Azzopardi, Lilian M, Serracino-Inglott, Anthony
• Format: Journal Article
• Language: English
• Published: Spain Centro de Investigaciones y Publicaciones Farmaceuticas, S.L 01.01.2019; Centro de Investigaciones y Publicaciones Farmaceuticas; Centro de Investigaciones y Publicaciones Farmacéuticas
• Subjects: Aged; Atrial Fibrillation; Cardiac arrhythmia; Clinical Audit; Disease Management; Documentation; Drug therapy; Drug Utilization Review; Inappropriate Prescribing; Malta; Medication Therapy Management; Original Research; Pharmaceutical Services; Pharmacists; Pharmacology & Pharmacy; Researchers; Inappropriate Prescribing; Medication Therapy Management; Pharmaceutical Services; Aged; Disease Management; Drug Utilization Review; Pharmacists; Atrial Fibrillation; Clinical Audit; Malta
• ISSN: 1885-642X; 1886-3655; 1886-3655; 1696-1137
• DOI: 10.18549/PharmPract.2019.1.1349

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