Impact of a Clinical Pharmacist Telehealth Service in a Geriatrics Assessment Clinic.

Evaluate the impact of a telepharmacy service at a geriatrics assessment clinic. Retrospective, single-center, nonblinded cohort study. Geriatrics assessment clinic. The intervention/pharmacist and the control/no-pharmacist (provider) group included patients new to the clinic 50 years of age or older from over the span of 4 months. Patients who the pharmacist was unable to reach and those who missed appointments with the provider were excluded. The pharmacist phoned new patients approximately one week prior and one week after their first appointments with a provider. Primary outcome: number of drug-related problems (DRPs) detected by the pharmacist compared with the provider. Secondary outcomes: number of medication history discrepancies, accepted medication-related recommendations, potentially inappropriate medications (PIMs) deprescribed, and adverse drug reactions (ADRs) detected. In the intervention/pharmacist (n = 204) vs control/no pharmacist (n = 200) groups, the number of DRPs was significantly greater (338 vs 218; 0.031) and driven by unnecessary drug therapies, doses too high, ADRs, and drug-drug interactions (230 vs 147, 0.045; 37 vs 7, 0.010; 36 vs 17, 0.023; 32 vs 1, 0.003, respectively). The difference in number of recommendations made by the pharmacist vs medication changes made by the provider was significant: 457 vs 319, 0.001, respectively. The addition of a clinical pharmacist conducting telepharmacy at a geriatrics assessment clinic had a positive impact on patient care as it relates to DRPs, deprescribing PIMs, and optimizing medication adherence.