Journal of geriatric cardiology : JGC · 2026
Integrated drug management for elderly patients with congestive heart failure: enhancing medication accuracy using the MINE (Medicine IN gEriatric) application.
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Ayu Welinda Dyah, Athiyah Umi, Gunawan Carta Agrawanto, Zairina Elida
Аннотация
BACKGROUND: This study evaluated the impact of the Medicine IN Geriatric (MINE) application, which integrates the Integrated Medicine Management (IMM) model and STOPP/START criteria, on improving prescribing practices in elderly patients with congestive heart failure (CHF).
METHODS: A two-phase study was conducted: validation of the IMM model and its implementation via the MINE app. A quasi-experimental pretest-posttest control group design was used in a hospital in East Kalimantan, Indonesia. Patients aged 60-79 years were randomly assigned to the intervention or control group. The intervention group received IMM-based pharmaceutical services, including medication reconciliation, repeated medication reviews, and individualized discharge counseling. The outcomes assessed included polypharmacy rates, potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs), and health-related quality of life, using the EQ-5D-5L and EQ-VAS tools.
RESULTS: Expert validation showed high content validity, with I-CVI ≥ 0.86 and S-CVI = 0.94. During implementation, the use of antiplatelets, statins, angiotensin converting enzyme inhibitors (ACEI), and angiotensin receptor β-blockers (ARB) declined from admission to discharge. PIMs, such as beta-blockers in patients with conduction disorders and ACE-I/ARBs in those with hyperkalemia, also decreased. The intervention group's EQ-5D-5L scores improved from 0.552 to 0.664, whereas the control group's scores declined slightly. EQ-VAS scores also increased significantly in the intervention group.
CONCLUSION: The MINE-based IMM intervention effectively reduced inappropriate prescribing and enhanced the quality of life in elderly patients with CHF. This technology-enabled multidisciplinary approach supports safer prescribing in geriatric care.
METHODS: A two-phase study was conducted: validation of the IMM model and its implementation via the MINE app. A quasi-experimental pretest-posttest control group design was used in a hospital in East Kalimantan, Indonesia. Patients aged 60-79 years were randomly assigned to the intervention or control group. The intervention group received IMM-based pharmaceutical services, including medication reconciliation, repeated medication reviews, and individualized discharge counseling. The outcomes assessed included polypharmacy rates, potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs), and health-related quality of life, using the EQ-5D-5L and EQ-VAS tools.
RESULTS: Expert validation showed high content validity, with I-CVI ≥ 0.86 and S-CVI = 0.94. During implementation, the use of antiplatelets, statins, angiotensin converting enzyme inhibitors (ACEI), and angiotensin receptor β-blockers (ARB) declined from admission to discharge. PIMs, such as beta-blockers in patients with conduction disorders and ACE-I/ARBs in those with hyperkalemia, also decreased. The intervention group's EQ-5D-5L scores improved from 0.552 to 0.664, whereas the control group's scores declined slightly. EQ-VAS scores also increased significantly in the intervention group.
CONCLUSION: The MINE-based IMM intervention effectively reduced inappropriate prescribing and enhanced the quality of life in elderly patients with CHF. This technology-enabled multidisciplinary approach supports safer prescribing in geriatric care.