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Table 2 Detected DRPs in patients during the control- and intervention-period using the GheOP3s tool

From: Introducing a pharmacist-led transmural care program to reduce drug-related problems in orthogeriatric patients: a prospective interventional study

Drug-Related Problems (DRPs)

Control

(n = 223)

Control

1 month after discharge

(n = 178)

Intervention

(n = 223)

Intervention 1 month after discharge

(n = 99)

Part 1: potentially inappropriate drugs, independent of diagnosis

 Opioids

30 (14.9)

18 (10.1)

21 (9.4)

12 (12.1)

 PPIa >8 weeks

19 (9.4)

22 (12.3)

32 (14.3)

14 (14.1)

 Benzodiazepines or Z-drugs

18 (9.0)

25 (14.0)

21 (9.4)

16 (16.2)

 Acetylsalicylic acid > 100 mg/day

16 (8.0)

3 (1.7)

10 (4.5)

0 (0)

 Antidepressants > 1 year

6 (3.0)

7 (3.9)

8 (3.6)

2 (2.0)

 Systemic NSAIDsb

3 (1.5)

5 (2.8)

6 (2.7)

1 (1.0)

 Centrally-acting antihypertensives

2 (1.0)

2 (1.1)

2 (0.9)

1 (1.0)

 Alizapride

2 (1.0)

0 (0)

0 (0)

0 (0)

 Antipsychotics > 1 month

1 (0.5)

1 (0.6)

5 (2.2)

4 (4.0)

 Contact laxatives for daily use > 2 weeks

1 (0.5)

2 (1.1)

5 (2.2)

3 (3.0)

 Metoclopramide

1 (0.5)

1 (0.6)

1 (0.4)

0 (0)

 Barbiturates

1 (0.5)

1 (0.6)

0 (0)

0 (0)

 Oral decongestants

1 (0.5)

2 (1.1)

0 (0)

0 (0)

 Long-acting sulphonylurea derivatives

0 (0)

0 (0)

1 (0.4)

0 (0)

 Narcotic antitussives

0 (0)

2 (1.1)

0 (0)

0 (0)

 Sedating antihistaminic

0 (0)

1 (0.6)

0 (0)

0 (0)

Part 2: potentially inappropriate drugs, dependent of diagnosis

 Drugs likely to cause constipation in patients with known constipation

14 (6.9)

11 (6.2)

15 (6.7)

6 (6.1)

 Drugs with anticholinergic properties with known dementia/cognitive impairment

6 (3.0)

6 (3.4)

4 (1.8)

2 (2.0)

 Systemic predniso(lo)ne-equivalents > 7.5 mg/day with diabetes

1 (0.5)

1 (0.6)

1 (0.4)

1 (1.0)

 Drugs with anticholinergic properties with known benign prostatic hyperplasia

1 (0.5)

1 (0.6)

1 (0.4)

0 (0)

Part 3: Potentially omitted medication in older people

 Opioids without laxative

18 (8.9)

8 (4.5)

8 (3.6)

0 (0)

 Osteoporotic therapy without adequate calcium/vitamin D

6 (3.0)

4 (2.2)

4 (1.8)

1 (1.0)

 Predniso(lo)ne-equivalent of ≥ 7.5 mg for ≥ 3 months without calcium/vitamin D supplementation and bisphosphonate

2 (1.0)

1 (0.6)

1 (0.4)

0 (0)

Part 4: Drug-Drug interactions of specific relevance

 Combination of FRIDs

29 (14.4)

29 (16.3)

35 (15.7)

21 (21.2)

 Combination of drugs with anticholinergic properties

8 (4.0)

7 (3.9)

17 (7.6)

11 (11.1)

 Combination of QT prolonging drugs or combination of QT prolonging drug and drug that inhibits metabolism of this drug

6 (3.0)

5 (2.8)

13 (5.8)

4 (4.0)

 Combination of drugs leading to increased bleeding risk

5 (2.5)

7 (3.9)

5 (2.2)

0 (0)

 RAASc inhibitor + potassium sparing diuretic/potassium supplement/potassium containing drug

1 (0.5)

1 (0.6)

4 (1.8)

0 (0)

 Systemic NSAID + RAAS inhibitor

1 (0.5)

3 (1.7)

3 (1.3)

0 (0)

 Oral antidiabetics with risk of hypoglycaemia/insulin + non-selective β-blocker

1 (0.5)

1 (0.6)

0 (0)

0 (0)

 Systemic NSAID + Diuretic

1 (0.5)

1 (0.6)

0 (0)

0 (0)

  1. aPPI proton-pump inhibitors
  2. bNSAIDs Non-steroidal anti-inflammatory drugs
  3. cRAAS Renin-angiotensin-aldosteronesystem