A Comparative Analysis of an Original vs. Expert-Reviewed Treatment Plan for a Polymedicated Nursing Home Resident

Polypharmacy is a common phenomenon among elderly nursing home residents and is often associated with drug-drug interactions (DDIs) that may compromise treatment efficacy and patient safety. Clinical pharmacists and pharmacologists play a vital role in identifying and mitigating potential DDIs, thereby contributing to safer and more effective care. This study evaluates the treatment plan of a polymedicated nurs­ing home resident using the UpToDate Drug Interaction Checker to identify algorithm-based DDIs and assess their severity. The original regimen was then compared with three alternative treatment plans independently proposed by clinical experts. Each expert reviewed the patient’s medical history and medication profile, aim­ing to reduce adverse events and potential interactions. The revised regimens were compared to the original using the Jaccard Index and Fleiss’ Kappa statistic. The original plan comprised 19 medications. Experts 1 and 2 retained 52.63% of the medications, while Expert 3 retained 47.36%. Expert 2 replaced six drugs to improve respiratory function, potassium balance, and psychiatric care, while Expert 3 altered the patient’s antihyper­tensive therapy. The Jaccard Index values were 0.52, 0.50, and 0.45 for Experts 1, 2, and 3, respectively. Fleiss’ Kappa was 0.36, indicating fair inter-rater agreement. Overall, potential DDIs were reduced by an average of 60%. Despite overlapping choices, the variability in expert recommendations underscores the complexity of pharmacotherapy in polymedicated elderly patients and the critical importance of interdisciplinary collabora­tion in geriatric care.