Integrated drug management for elderly patients with congestive heart failure: enhancing medication accuracy using the MINE (Medicine IN gEriatric) application.

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.