Evidence map›Paper›PMID 40959457›Full record

ArticleFrontiers in pharmacology2025

Clinical pharmacist interventions in medication review for medication optimization in older hospitalized adults with mental disorders and somatic comorbidities: evidence from retrospective study.

Matej Stuhec, Nusa Svetanic, Tomaz Vovk, Anteja Gorjan Gazdag, Zala Cuk, Borjanka Batinic

Abstract read
In one paragraph

Article in Frontiers in pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Matej StuhecDepartment of Pharmacology & Department of Clinical Pharmacy, Medical Faculty Maribor, University of Maribor, Maribor, Slovenia.
Nusa SvetanicDepartment of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.
Tomaz VovkDepartment of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.
Anteja Gorjan GazdagDepartment of Clinical Pharmacy, Ormoz's Psychiatric Hospital, Ormoz, Slovenia.
Zala CukDepartment of Clinical Pharmacy, Ormoz's Psychiatric Hospital, Ormoz, Slovenia.
Borjanka BatinicClinic of Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Collaboration with clinical pharmacists in the medication review process can potentially optimize pharmacotherapy for elderly patients with mental disorders and somatic comorbidities. Aim: This study aimed to evaluate the impact of clinical pharmacists' recommendations during medication reviews, including changes in the number of medications, potentially inappropriate medications (PIMs), potential drug-drug interactions (DDIs), and adherence to treatment guidelines. Methods: A retrospective, non-interventional study was conducted in a psychiatric hospital in Slovenia. The study included inpatients aged ≥65 years with mental disorders who were referred for medication reviews between 2013 and 2018 and had at least one therapy modification related to somatic comorbidities (heart failure, arterial hypertension, or diabetes). Clinical pharmacists conducted type 3 medication reviews (advanced medication reviews), as defined by the Pharmaceutical Care Network Europe They recorded their recommendations in the hospital's electronic system immediately after completing the medication review. Data from before (before the medication review) and after (outcomes extracted from the electronic system at discharge) were systematically reviewed. The primary outcomes were changes in the number of medications, PIMs, and DDIs before and after the intervention. The secondary outcome was adherence to treatment guidelines for somatic comorbidities (heart failure, arterial hypertension, and diabetes). Results: The study included 100 inpatients with a mean age of 78.1 years (SD = 6.78). The total number of medications decreased by 6.6% (from 1,144 to 1,068; p < 0.001), with an acceptance rate of 59.2%. After the review, X-type DDIs decreased by 75.8% (from 33 to 8; p < 0.001), and D-type DDIs decreased by 56.9% (from 188 to 81; p < 0.001). The number of PIMs also significantly decreased (p < 0.001), with reductions of 29.5% (from 308 to 217) based on the Priscus List and 17.5% (from 343 to 283) according to the Beers Criteria. Adherence to treatment guidelines for somatic comorbidities improved significantly (from 3.3%-13.2% to 50.0%-72.6%; p < 0.001). Conclusion: This study demonstrates that interventions by clinical pharmacists during the medication review process effectively reduced the number of medications, PIMs, and DDIs while significantly improving adherence to treatment guidelines.

Indexed as

clinical pharmacydrug-related problemhospitalmedication reviewpsychiatry

Identifiers

PMID40959457
PMCPMC12433881

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.