Preventing Adverse Drug Reactions in Older Australians

We developed and validated a risk score (the PADR-EC score) for ADR-related hospitalization in older patients. We will conduct an open-label randomized controlled trial to investigate the effectiveness of an intervention to reduce the risk of ADRs during and following hospitalization compared to control. Patients 65 years or older who are admitted under the care of a medical team at the Royal Hobart Hospital will be approached to provide their consent. Their nominated general practice and community pharmacy will also be provided with relevant information to enable follow up. All patients will undertake a comprehensive interview to establish their baseline risk of ADRs using an ADR risk score, and will then be randomized to the intervention or control group using a central randomization service. For intervention patients, in addition to usual care, a clinical pharmacist researcher will prepare a comprehensive ADR risk assessment and medication management plan based on the level of risk (low/moderate/high), which will be shared with the clinical team during the hospitalization to inform in-hospital care. The ADR risk assessment is done using the PADR-EC score. The PADR-EC score was developed based on ADR admissions to the hospital to identify people at high risk of ADRs and uses the risk factors of recent medication changes, inappropriate anticholinergic drugs, dementia, renal impairment, and multiple antihypertensives to categorize the risk of ADRs. The management plan includes considering the following factors that impact on the PADR-EC score and ADR risk • Recent medication changes • Renal impairment defined as eGFR less than 60mL/min • Dementia – is there a documented diagnosis in the notes? • Number of antihypertensives • Anticholinergic medications • Any other clinically relevant drug-related problems that could lead to ADRs This will also form a part of the discharge plan, which will be communicated to each intervention patient’s nominated GP and community pharmacy. The best possible medication history is collected from the patients and their relatives and/or caregivers, their general practitioner, and/or community pharmacy. The patients’ previous admission/discharge details are also stored as an electronic patient file or digital medical record, which could also be accessed during the study for any missing information.