30 | Impact of pharmacist–clinician collaboration on polypharmacy optimization in frail older patients: preliminary results

A. Franceschin¹, P. Singh², G. Annessi¹, G. Lacerenza¹, G. Formoso³, E.L.C.M. Bassi², L. Franchi¹ | ¹Unità Internistica Multidisciplinare ad indirizzo Geriatrico Riabilitativo, Ospedale San Sebastiano di Correggio (RE); ²Unità Farmaceutica Ospedale San Sebastiano di Correggio (RE); ³Struttura Complessa di Farmacoepidemiologia, Azienda USL di Reggio Emilia e Centro Regionale Farmacovigilanza, Regione Emilia Romagna.

Introduction. Polypharmacy in frail elderly patients is associated with an increased risk of inappropriate prescribing, drug–drug interactions, anticholinergic burden, and adverse clinical outcomes.

Objectives. To evaluate the impact of a multidisciplinary medication review, based on collaboration between a hospital pharmacist and a ward clinician, on prescribing appropriateness in elderly patients with polypharmacy.

Materials and Methods. This prospective, observational, single-center study includes patients aged ≥65 years admitted to an Internal Medicine Rehabilitation Unit and receiving ≥5 chronic medications. Enrollment began in February 2026 and will continue until July 2026. Patients with a Clinical Frailty Scale (CFS) score >7 were excluded. Medication review is conducted by a hospital pharmacist in collaboration with the ward clinician using STOPP/START and Beers criteria, the Anticholinergic Cognitive Burden (ACB) score, and drug–drug interaction assessment. Identified issues are discussed with the clinician, who makes the final decision regarding implementation.

Results. Preliminary data include 12 patients (mean age 86 years; mean Clinical Frailty Scale 6.1), indicating a high level of frailty. The mean number of medications at baseline was 11.0. A total of 23 pharmacological recommendations were made, of which 15 (65.2%) were accepted. The most frequently involved drug classes were central nervous system and cardiovascular agents. Interventions mainly consisted of deprescribing and dose optimization, resulting in a mean reduction of 1.54 medications per patient.

Conclusions. Multidisciplinary collaboration between hospital pharmacists and clinicians appears to be an effective strategy for optimizing pharmacotherapy in frail elderly patients, improving prescribing appropriateness in real-world clinical practice. A one-month telephone follow-up is conducted to assess adherence to implemented changes and to identify any new drug-related problems.