Research on risk assessment of polypharmacy and pharmaceutical care for elderly diabetic patients

LIU Le; ZHENG Jiaan; XIE Jianling

Abstract：Objective:To screen for potentially inappropriate medication(PIM)in elderly hospitalized patients with diabetes using the American Geriatrics Society 2019 Updated AGS Beers Criteria,analyze PIM incidence,establish a pharmaceutical care pathway,and explore the role of clinical pharmacists in managing polypharmacy.Methods:All 368 elderly patients with diabetes hospitalized in the Endocrinology Department of Ningcheng County Central Hospital,Chifeng City,from February 2022 to August 2023 were enrolled.Patients were stratified into PIM group(n=127)and non-PIM group(n=241)based on the Beers Criteria(2019 edition).For the PIM group,potential risk assessments and pharmaceutical interventions were implemented.The study analyzed characteristics of polypharmacy and PIM dis-tribution in local elderly diabetic patients,comparing therapeutic efficacy,safety,and cost-effectiveness before and af-ter pharmacist interventions to develop a clinical pharmacist-led care pathway.Results:Among 368 enrolled elderly di-abetic patients with polypharmacy,127 cases(36.14％)exhibited PIM,totaling 133 PIM instances.The top five PIM with the highest incidence rate are aspirin as primary prevention of cardiovascular events,long-acting sulfonylureas,sliding dose insulin,proton pump inhibitors,benzodiazepines with short-acting and medium-acting effects.There were statistically significant differences between PIM group and non-PIM group in age,types of diseases and types of drugs used(P＜0.05).After the intervention of clinical pharmacists,there was no significant difference in the effective rate,the incidence of adverse reactions and the average hospitalization expenses between the two groups(P＞0.05).Conclusion:The incidence of PIM in elderly diabetic inpatients with polypharmacy is high.For patients with multiple chronic diseases and diabetic complications,clinical pharmacists should routinely use the Beers Criteria to screen for PIM and conduct risk assessments,and establish a pharmaceutical care pathway,which can ensure the effectiveness and safety of medications and reduce the economic burden on patients.