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OBJECTIVE: To assess a community pharmacist-provided targeted medication review (TMR) intervention to reduce the number of falls risk-increasing drugs (FRIDs) prescribed to older patients in a community pharmacy setting. DESIGN: A single-site, prospective, interventional pilot study with a historical control group. SETTING: A single independent community pharmacy in rural Western New York. PARTICIPANTS: A convenience sample of subjects was recruited for the intervention group based on the following inclusion criteria: 65 years of age or older, at least one prescription filled at the pharmacy within the past 90 days from date of enrollment in study, enrolled in a local Medicare plan, and prescription for at least one prespecified FRID filled at the pharmacy within 90 days before date of enrollment in study. A control group was collected that had different Medicare Part D plans than the intervention group but otherwise met inclusion criteria and ensured that between all of the control-group patients we included at least one patient prescribed each of the FRID classes that were found in the intervention group. Thirty-six subjects completed the study intervention, and 63 controls were collected. This offset in numbers between groups resulted from intervention subjects taking multiple FRIDs and the control needing to take the same class of FRID, thus one intervention subject may have required multiple control subjects to parallel each FRID class. INTERVENTION: The intervention involved the community pharmacist assessing the patient’s fall risk, then educating the patient on the risks of the FRID he or she was prescribed, and recommending to either replace or discontinue the FRID. The outcomes assessment occurred three months later, with the pharmacist repeating the falls-risk assessment and following up regarding the patient’s agreed-upon action plan. RESULTS: The intervention group had 52 FRIDs identified while the control group had 89. The discontinuation rate of FRIDs at three months was significantly higher in the intervention group (7.7% versus 0%; P = 0.0172). CONCLUSION: This study demonstrated that a community pharmacist TMR intervention can reduce the use of FRIDs. [ABSTRACT FROM AUTHOR]

Objective: This study sought to compare the appropriateness of antibiotic prescribing by drug, dose, duration, and indication between the emergency department (ED) and primary care (PC) within the Veterans Affairs Western New York Healthcare System (VAWNYHCS) to aid in focusing antimicrobial stewardship efforts.Design: In this prospective observational cohort study, patients were identified using electronic alerts at the time of antibiotic prescribing. Prescriptions were retrospectively analyzed for appropriateness of antibiotic indication, drug choice, dose, and duration on the basis of current guideline recommendations. Data were compared between the ED and PC to determine the impact of visit location on prescribing habits. Baseline characteristics were compared using descriptive statistics, and a multivariable analysis was performed to identify statistically significant risk factors for inappropriate prescribing.Setting and Participants: Patients prescribed outpatient antibiotics at the VAWNYHCS ED and PC settings between June 2017 and February 2018.Outcome Measures: Appropriateness of antibiotic prescribing by drug, dose, duration, and indication between the ED and PC settings.Results: The cohort included 1566 antibiotic prescriptions (ED = 488, PC = 1078). The appropriate drug, dose, and duration for antibiotics prescribed in the ED versus PC were 63.1% versus 43.4% (P < 0.001), 88.1% versus 88.2% (P = 0.953), and 86.1% versus 71.1% (P < 0.001), respectively. Azithromycin was the most inappropriately prescribed antibiotic in both the ED (37.8%) and PC (49.0%). Two factors predicted whether patients received the correct antibiotic empirically: location of the visit and antibiotic allergy. Overall, 56.6% of ED prescriptions and 82% of PC prescriptions were inappropriate with respect to at least 1 component.Conclusion: Stewardship is needed in both the ED and PC settings. However, initial efforts should be focused on PC because this setting had a statistically significant amount of inappropriate antibiotic prescribing. Pharmacist-led education and interventions should focus on the determination of drug, duration, and indication for the use of antibiotics. [ABSTRACT FROM AUTHOR]