ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1667584
This article is part of the Research TopicEvidence for Assessing Drug Safety and Drug Use in Older People: Volume IIIView all articles
Clinical Pharmacist Interventions in Medication Review for Medication Optimization in Older Hospitalized Adults with Mental Disorders and Somatic Comorbidities: Evidence from Retrospective Study
Provisionally accepted
- 1Faculty of Medicine, University of Maribor, Maribor, Slovenia
- 2Psihiatricna bolnisnica Ormoz, Ormož, Slovenia
- 3University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
- 4University Clinical Centre of Serbia, Clinic of Psychiatry, Belgrade, Serbia, Belgrade, Serbia
- 5University of Belgrade, Faculty of Philosophy, Department of Psychology, Belgrade, Serbia, Belgrade, Serbia
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Collaboration with clinical pharmacists in the medication review process can potentially optimize pharmacotherapy for elderly patients with mental disorders and somatic comorbidities.Aim: This study aimed to evaluate the impact of clinical pharmacists' recommendations during medication reviews, including changes in the number of medications, potentially inappropriate medications (PIMs), potential drug-drug interactions (DDIs), and adherence to treatment guidelines.A retrospective, non-interventional study was conducted in a psychiatric hospital in Slovenia. The study included inpatients aged ≥65 years with mental disorders who were referred for medication reviews between 2013 and 2018 and had at least one therapy modification related to somatic comorbidities (heart failure, arterial hypertension, or diabetes). Clinical pharmacists conducted type 3 medication reviews (advanced medication reviews), as defined by the Pharmaceutical Care Network Europe (PCNE). They recorded their recommendations in the hospital's electronic system immediately after completing the medication review. Data from before (before the medication review) and after (outcomes extracted from the electronic system at discharge) were systematically reviewed. The primary outcomes were changes in the number of medications, PIMs, and DDIs before and after the intervention. The secondary outcome was adherence to treatment guidelines for somatic comorbidities (heart failure, arterial hypertension, and diabetes).The study included 100 inpatients with a mean age of 78.1 years (SD = 6.78). The total number of medications decreased by 6.6% (from 1,144 to 1,068; p < 0.001), with an acceptance rate of 59.2%. After the review, X-type DDIs decreased by 75.8% (from 33 to 8; p < 0.001), and D-type DDIs decreased by 56.9% (from 188 to 81; p < 0.001). The number of PIMs also significantly decreased (p < 0.001), with reductions of 29.5% (from 308 to 217) based on the Priscus List and 17.5% (from 343 to 283) according to the Beers Criteria.Adherence to treatment guidelines for somatic comorbidities improved significantly (from 3.3-13.2% to 50.0-72.6%; p < 0.001).This study demonstrates that interventions by clinical pharmacists during the medication review process effectively reduced the number of medications, PIMs, and DDIs while significantly improving adherence to treatment guidelines.
Keywords: Psychiatry, Clinical Pharmacy, Hospital, medication review, Drug-related problem
Received: 16 Jul 2025; Accepted: 22 Aug 2025.
Copyright: © 2025 Stuhec, Svetanic, Vovk, Gorjan Gazdag, Cuk and Batinic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Matej Stuhec, Faculty of Medicine, University of Maribor, Maribor, Slovenia
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.