Pharmaceutical management of elderly patients in the perioperative setting - PHAROS

Elderly, multimorbid patients represent a growing proportion of patients who have to undergo surgical intervention in hospital. Multimedication and potentially inadequate medication, i.e. drugs that may have unfavourable effects due to altered pharmacodynamics in the elderly, increase the perioperative risk of this vulnerable patient group. The aim of the research project "Pharmaceutical Management of Elderly Risk Patients in the Perioperative Setting" (PHAROS) was to investigate whether preoperative optimisation of long-term medication can improve the appropriateness of medication in elderly risk patients, reduce drug-related problems and prevent information losses between the outpatient and inpatient sectors. This project was designed as a pilot study in a before-and-after design. Patients over 64 years of age with an increased perioperative risk, calculated from the disease burden and invasiveness of the upcoming surgery (POSPOM score) as well as a permanent intake of more than four medications were included in the study. The intervention consisted of a pharmaceutical medication history a few days after inclusion in the study, a subsequent pharmaceutical medication analysis and - if medication-related problems or potentially inadequate medication were identified - a recommendation to the general practitioners to optimise the patient's long-term medication by changing it preoperatively. The time points for data collection were 3 weeks preoperatively, admission and discharge from hospital, and 3 months postoperatively. The primary endpoint was a change in the Medication Appropriate Index between the control and intervention groups. Secondary endpoints were the occurrence of postoperative complications, the frequency of medication-related problems (AbP) and potentially inadequate medication (PIM), patient satisfaction with outpatient and inpatient care, the correct medication during transitions in the treatment process (medication reconciliation) and health-related quality of life. It was shown that neither the appropriateness of medication nor the secondary endpoints differed between the control and intervention groups. In 34% of the cases, a change in medication was recommended, but this only took place in 6% percent. Barriers to the implementation of the intervention were mainly identified as difficult intersectoral communication and insufficient time between medication analysis and planned surgery. The pharmaceutical intervention was assessed as positive and necessary by all professional groups and patients involved. The further development of a suitable intervention that can sustainably reduce the risk of drug-related problems in the perioperative setting in clinical routine should remain the focus of future scientific projects.