Implementation of inter-departmental collaborative medication review to reduce potentially inappropriate medication use in the hospitalized elderly patients: A mixed method study

Rationale: The inappropriate use of multiple medications, known as polypharmacy, is a growing concern for the elderly population in India, who are often prescribed multiple medications due to comorbid conditions. This can lead to serious adverse health outcomes, increased healthcare costs, and reduced quality of life. Screening tools, such as Medication Appropriateness Index and START/STOPP criteria, can help identify potentially inappropriate medications (PIMs), and interventions, such as medication review clinics and prescribing audits, can help improve

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appropriateness. Collaborative medication review involving a team approach is important to ensure that patients receive the best possible care. However, cost of these interventions remains a concern, especially in a country where healthcare spending is high for the elderly population.

Primary Objective: To assess the feasibility of implementation of inter-departmental Collaborative Medication Review (CMR) to reduce potentially inappropriate medications (PIMs) in the hospitalised elderly patients. Secondary Objectives:

a) To explore the facilitators and barriers in the implementation of inter-departmental CMR from the healthcare providers perspective b) To determine the costs involved in the implementation of inter-departmental CMR from health system perspective

c) To find out the efficacy of interdepartmental CMR using medication appropriateness index (MAI), post discharge adverse events and number of medication related admissions.

Methods: This study design will be a mixed method study, where the qualitative component will assess the feasibility of the collaborative medication review using in-depth interview and Focussed Group Discussion to explore the challenges in the implementation of interdepartmental collaborative medication review to reduce PIMs in the hospitalised elderly patients and the quantitative component of the study will estimate the costs incurred for the implementation of CMR in healthcare settings and reduction in the percentage of potentially inappropriate medications using START/STOPP criteria, medication appropriateness index (MAI) and post discharge adverse events. AT-HARM10 tool will be used to identify hospital admissions related to medications. A total of 280 hospitalised elderly participants’ prescriptions will be analysed in both the study sites from the admission day till 30 days post discharge by the CMR team members.

Expected Study outcomes:

• Facilitators and barriers in implementing CMR in different types of Indian healthcare setting