Interprofessional medication review shows non-significant improvement in prescribing appropriateness for older ED patients

AIMS: To evaluate the efficacy of a structured, patient-oriented, interprofessional medication review on inappropriate prescribing compared to standard care in the emergency department (ED). METHODS: In this protocolized analysis from a randomized controlled trial, 151 older adults (≥65 years) admitted to the ED of Copenhagen University Hospital Hvidovre, Denmark, between 2018 and 2021 were randomized to receive a medication review by a clinical pharmacist and geriatrician (intervention group [IG]) or standard care (control group [CG]). The primary outcome was the change in Medication Appropriateness Index (MAI) score from inclusion to 8-week follow-up. Efficacy was evaluated by analysis of covariance, adjusting for MAI score at inclusion. Secondary outcomes included change in the Assessment of Underutilization score, number of medications and number of potentially inappropriate medications. RESULTS: The mean (standard deviation) improvement in MAI score from inclusion to 8-week follow-up was 2.2 (6.6) points for the IG, compared to 1.2 (5.5) points for the CG (P = 0.3). The most common causes of inappropriate prescribing were lack of indication, incorrect dose and inappropriate duration of use. A total of 295 (18.6%) medications were deprescribed from inclusion to 8-week follow-up, including 170 (21.3%) in the IG and 125 (15.9%) in the CG. The intervention did not have a notable effect on secondary outcomes. CONCLUSIONS: The structured, patient-oriented, interprofessional medication review improved the MAI score at 8 weeks, but this improvement was not statistically significant compared to standard care. Deprescribing was identified as an important strategy for improving medication appropriateness and represents an important intervention for future research.