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Background <p>Geriatric inpatients are vulnerable to medication-related harm, yet effective interventions remain scarce. The ASPIRE randomized controlled trial evaluated a pharmacist-led intervention aimed at reducing unplanned hospital revisits through comprehensive medication reviews targeting inappropriate pharmacotherapy and polypharmacy.</p> Methods <p>This study assessed the intervention’s impact on medication appropriateness and medication burden at admission, discharge, and 1 month post-discharge in patients admitted to an acute geriatric ward. Medication appropriateness was measured using the Medication Appropriateness Score (MAS), summating STOPP and START criteria version 3, and by tracking reductions in potentially inappropriate medications (PIMs) as measured by STOPP and potential prescribing omissions (PPOs) according to START. Medication burden was assessed through changes in total medication count, polypharmacy (≥ 5 drugs), and excessive polypharmacy (≥ 10 drugs). Univariable and multivariable linear mixed models and generalized estimating equations were applied for continuous and dichotomous outcomes respectively. Data were collected from electronic health records and contact with patients, family members, and healthcare professionals.</p> Results <p>The trial included 415 intervention and 410 control patients with a mean age of 86.3 (±&#xa0;5.9) years. Multivariable linear mixed models showed significant improvements in MAS (<i>β</i> = −&#xa0;0.97 at discharge, <i>β</i> = −&#xa0;0.93 1 month post-discharge), PIMs (β = -0.85 at both time points) and PPOs (<i>β</i> = −&#xa0;0.25 at discharge, <i>β</i> = −&#xa0;0.24 1 month post-discharge) between intervention and control patients (all <i>p</i> &lt; 0.0001). There was no reduction in medication count, polypharmacy, or excessive polypharmacy.</p> Conclusions <p>The ASPIRE intervention significantly improved medication appropriateness in patients admitted to an acute geriatric ward without reducing overall medication burden, resulting in a shift from inappropriate to appropriate polypharmacy.</p> Trial Registration Number and Date of Registration <p>NCT04617340, 2020-10-29.</p>

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Effect of a Multifaceted Pharmacist-Led Intervention on Medication Appropriateness and Medication Burden in Patients Admitted to an Acute Geriatric Ward: Results from the ASPIRE Trial

  • 期刊论文

  • 发表日期：

    2026年1月31日

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  • Laura Hellemans,
  • Lotte Blocquiaux,
  • Julie Hias,
  • Karolien Walgraeve,
  • Astrid Liesenborghs,
  • Astrid Lammens,
  • Mieke Deschodt,
  • Jos Tournoy,
  • Lorenz Van der Linden

摘要

Background

Geriatric inpatients are vulnerable to medication-related harm, yet effective interventions remain scarce. The ASPIRE randomized controlled trial evaluated a pharmacist-led intervention aimed at reducing unplanned hospital revisits through comprehensive medication reviews targeting inappropriate pharmacotherapy and polypharmacy.

Methods

This study assessed the intervention’s impact on medication appropriateness and medication burden at admission, discharge, and 1 month post-discharge in patients admitted to an acute geriatric ward. Medication appropriateness was measured using the Medication Appropriateness Score (MAS), summating STOPP and START criteria version 3, and by tracking reductions in potentially inappropriate medications (PIMs) as measured by STOPP and potential prescribing omissions (PPOs) according to START. Medication burden was assessed through changes in total medication count, polypharmacy (≥ 5 drugs), and excessive polypharmacy (≥ 10 drugs). Univariable and multivariable linear mixed models and generalized estimating equations were applied for continuous and dichotomous outcomes respectively. Data were collected from electronic health records and contact with patients, family members, and healthcare professionals.

Results

The trial included 415 intervention and 410 control patients with a mean age of 86.3 (± 5.9) years. Multivariable linear mixed models showed significant improvements in MAS (β = − 0.97 at discharge, β = − 0.93 1 month post-discharge), PIMs (β = -0.85 at both time points) and PPOs (β = − 0.25 at discharge, β = − 0.24 1 month post-discharge) between intervention and control patients (all p < 0.0001). There was no reduction in medication count, polypharmacy, or excessive polypharmacy.

Conclusions

The ASPIRE intervention significantly improved medication appropriateness in patients admitted to an acute geriatric ward without reducing overall medication burden, resulting in a shift from inappropriate to appropriate polypharmacy.

Trial Registration Number and Date of Registration

NCT04617340, 2020-10-29.