Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings

Ann Sinéad Doherty, Gary Adamson, John Mallett, Carmel Darcy, Anne Friel, Michael G. Scott, EF Ruth Miller

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BACKGROUND: Whilst attention has been paid within the literature to examining potentially inappropriate prescribing (PIP) for older adults in a variety of care settings, less is known about the extent within intermediate care. Furthermore, few studies have examined the utility of clinical pharmacist involvement in this care context.

OBJECTIVE(S): Determine the prevalence of PIP in intermediate care (IC) settings in Northern Ireland (NI), explore the utility of a novel pharmacist case management model at reducing PIP and to examine the association with subsequent healthcare utilisation.

METHODS: Secondary analysis of prospective data (N = 532) collected during a medicines optimisation pharmacist case management model in three intermediate care sites in NI. Independent prescriber pharmacists delivered the intervention. Variability in Medication Appropriateness Index score change (ΔMAI) from admission to discharge was examined using multivariate linear regression analysis. Multivariate logistic and Poisson regressions were used to examine the association between ΔMAI and likelihood and numbers of unplanned hospital readmissions within 30 and 90 days of IC discharge.

RESULTS: PIP was highly prevalent (89.5%) at baseline with significant reductions in MAI score achieved from admission (Median = 14) to discharge (Median = 0) (Z = -18.28, p < .001). The prevalence of PIP at discharge was 7.8%. No relationship was observed between ΔMAI score and unplanned hospital readmission. Those who received at least one educational intervention were less likely to be readmitted within 30 days of IC discharge (OR = 0.15, 95% CI 0.03, 0.71, p < .001). Baseline healthcare utilisation consistently predicted healthcare utilisation post-IC discharge.

CONCLUSIONS: Drug-related problems persist for many older adults following acute care discharge and intermediate care may provide an ideal location for medicines optimisation interventions.

Original languageEnglish
Pages (from-to)3669-3679
Number of pages10
JournalResearch in Social and Administrative Pharmacy
Issue number9
Early online date11 Apr 2022
Publication statusPublished (in print/issue) - 30 Sept 2022

Bibliographical note

Funding Information:
ASD received funding from Ulster University Vice Chancellor's Research Scholarship. EFRM received funding from the Western Health and Social Care Trust Research Discretionary Fund. The funders had no role in the design of the study, data collection, analysis or interpretation of data, writing of the manuscript nor the decision to submit for publication.

Publisher Copyright:
© 2022 Elsevier Inc.

Copyright © 2022 Elsevier Inc. All rights reserved.


  • Medicines optimisation
  • Potentially inappropriate prescribing
  • Pharmacist intervention
  • Case management
  • Healthcare utilisation


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