Medication-related problems in patients referred to aged care and memory clinics at a tertiary care hospital

Aim: To investigate the prevalence of medication-related problems (MRPs) in patients attending aged care and memory disorder clinics and explore the potential role of a clinical pharmacist to obtain medication histories and identify unresolved MRPs. Methods: The clinical pharmacist interviewed patients and reviewed their medication regimens in the outpatient clinics. Clinical significance of pharmacist-identified MRPs was rated by an independent expert panel using validated criteria. Results: Forty-six patients (mean age 82 years) were reviewed. They took a median of nine medications, of which three were not recorded in the medical record. One hundred and thirteen MRPs (median 2.0 per patient) were identified by the pharmacist. Independent review rated 35% of MRPs as high or extreme risk. Thirty-seven (33%) MRPs related to medications not recorded in the medical record. Conclusions: Medication-related problems were present for most patients. Involvement of a clinical pharmacist resulted in a more comprehensive medication history and identified unresolved MRPs.