Insights From Taipei Medical University Hospital

• By: CHIEN, Hsiu-Yu (Pharmacy Department of Taipei Medical University Hospital, China Taiwan)
• Co-author(s): Ms Hsiu-Yu Chien (Pharmacy Department of Taipei Medical University Hospital, Taipei, China Taiwan / School of Pharmacy, Taipei Medical University, Taipei, China Taiwan)
  Ms Yi-Fang Mu (Pharmacy Department of Taipei Medical University Hospital, Taipei, China Taiwan)
  Ms Er-Ying Wang (Pharmacy Department of Taipei Medical University Hospital, Taipei, China Taiwan / School of Pharmacy, Taipei Medical University, Taipei, China Taiwan)
  Mr Bi-Li Chen (Pharmacy Department of Taipei Medical University Hospital, Taipei, China Taiwan / School of Pharmacy, Taipei Medical University, Taipei, China Taiwan)
  
• Abstract:

  Optimizing Elderly Care: The Vital Role of Pharmacists - Insights from Taipei Medical University Hospital
  Hsiu-Yu Chien1,2, Yi-Fang Mu1, Er-Ying Wang1,2, Bi-Li Chen1,2
  1Department of Pharmacy, Taipei Medical University Hospital
  2School of Pharmacy, Taipei Medical University
  
  Introduction
  As individuals grow older, they often experience more health issues, leading to an increase in the variety of medications they need to take. According to literature, prescribing five or more types of medications is defined clinically as "polypharmacy." Studies based on Taiwan's National Health Insurance database, over 30% of the population is undergoing polypharmacy. And for disabled elderly individuals, it's as high as 81% and 38.1% even more than ten medications. To address this pressing issue, Taipei Medical University Hospital started the Integrated Geriatric/Polypharmacy Pharmaceutical Care Clinic in 2019. Our goal is to improve the quality of care for elderly patients with multiple medications.
  
  Method
  Pharmacists take a proactive approach, intervening in cases where patients are prescribed four or more chronic disease medications concurrently. A pharmaceutical service system with bidirectional communication platform was implemented in 2021, the system allows physicians to receive real-time assessment and recommendations from pharmacists during consultations, thereby enhancing the effectiveness and efficiency of communication between medical professionals and optimizing patient care.
  
  Results
  A total of 2,277 patients with four or more chronic prescriptions were admitted, 61% of whom were over 65 years old from 2019 to 2023. Findings from 2019 to 2023 revealed notable improvements:
  Inappropriate medication recommendations decreased from 28.7% to 23.8%. Physicians' acceptance rate of medication recommendations was steadily increasing from 68.4% to 84.1%. Recommendations for duplicate medications, drug interactions, and potentially inappropriate medications for the elderly decreased significantly from 43.2% to 20.2%. Additionally, there were 19 recommendations to initiate medication therapy. Polypharmacy was reduced with patients taking 20 or more medications were decreased by an average of 3 medications and 2.5 pills daily. Clinic visits decreased from an average of 7.8 to 4 times quarterly. These results demonstrate effective interventions in optimizing medication regimens, reducing polypharmacy, and minimizing clinic visits for elderly patients.
  
  Conclusion
  Patients taking multiple medications are at increased risk of inappropriate or unnecessary medication use, leading to adverse reactions and healthcare resource wastage. Polypharmacy is often unavoidable for those with multiple medical conditions. Therefore, the primary focus of pharmaceutical care for polypharmacy should be to ensure the necessity of each medication, rather than simply reducing the quantity or variety. Our Pharmaceutical Care Clinic emphasizes the importance of necessary treatments over the number of pills prescribed. As a result, the rate of medication recommendation declines, it means a gradual improvement in the appropriateness of medication usage among geriatric and polypharmacy patients. Our pharmaceutical care effectively enhances medication appropriateness for geriatric and polypharmacy patients, optimizing their health outcomes.