Abstract: Population aging is a global phenomenon. Each country in the world faces an increased
number of older persons in the total population. With aging, a high prevalence of multiple chronic
diseases occurs, leading to the use of complex therapeutic regimens and often to polypharmacy.
Potentially inappropriate medication (PIM) is a medicine prescribed to a patient for whom the risks
outweigh the benefits. Today, several tools are used to evaluate the use of pharmacotherapy in older
adults, one of them is the 2019 AGS Beers Criteria. In this prospective, pilot study, we aimed to
investigate if the number of PIMs in elderly patients would be significantly reduced if a clinical
pharmacist performed a pharmacotherapy review. The study included 66 patients over 65 years of
age who were hospitalized at the 1200-bed university hospital. The intervention was conducted by a
clinical pharmacist who reviewed the patients’ pharmacotherapy and provided written suggestions
to physicians. The pharmacotherapy was again reviewed at the patients’ discharge from the hospital.
A total number of 204 PIMs were identified in the pharmacotherapy of the study population. At
discharge, the number of PIMs decreased to 67. A total of 67% of the pharmacist’s suggestions were
accepted by the physicians. The pharmacist’s intervention led to significant decrease in the number
of PIMs on patients’ discharge letters.