Pharmacist-driven medication recognition/ reconciliation in older medical patients

Maria Teresa Chiarelli,Stefania Antoniazzi,Laura Cortesi,Luca Pasina,Alessio Novella,Francesca Venturini,Alessandro Nobili,Pier Mannuccio Mannucci,Cinzia Hu,Francesca Minonzio,Anna Ludovica Fracanzani, Federica Iuculanno,Nicola Montano,Eleonora Tobaldini,Daniela Mari,Paolo Rossi,Valter Monzani,Francesca Tantardini,Flora Peyvandi,Raffaella Rossio

European Journal of Internal Medicine（2021）

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摘要

•Recognition/reconciliation reduces inappropriate drug prescription in older medical patients.•A computerized aid program was thus adopted by hospital pharmacists and clinicians.•Many clinically significant drug-related problems were so identified.•The program led to deprescribing or closer drug monitoring.

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关键词

Multimorbidity,Polypharmacy,Drug related problems,Deprescribing

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