Pharmaceutical intervention model for prescribing cascades in Cuban older adults.
DOI:
https://doi.org/10.60103/phc.v28.e934Keywords:
Prescribing cascade; polypharmacy; older adult; pharmacists; primary health care; Cuba; patient safetyAbstract
Introduction: Prescribing cascades constitute a mechanism of avoidable iatrogenesis in polymedicated older adults, impacting patient safety and health systems. The research aims to develop an intervention model for the Cuban community pharmacist aimed at identifying and managing prescribing cascades in older adults, through the structured adaptation of validated international tools.
Method: A targeted synthesis of the international literature (2010-2025) was conducted to identify cascade identification tools involving pharmacist participation. These were subjected to a contextual adaptation process through a double filter: 1) pharmacological availability (congruence with the Cuban National Formulary of Medicines); and 2) clinical-operational relevance (potential frequency, severity of impact, and feasibility of detection in community pharmacy). A panel of researchers, through evaluation and consensus, carried out the process.
Results: The process generated three applicative products: 1) a prioritized checklist of ten high-risk prescribing cascades for the Cuban context, specifying mechanism, alert signal, and recommended collaborative action; 2) an intervention algorithm guiding the pharmacist from dispensing to structured communication with the family physician; and 3) a twelve-month phased implementation roadmap articulating validation, piloting, dissemination, and national scaling phases.
Conclusions: It is feasible to develop contextualized tools for intercepting prescribing cascades in health systems with integrated Primary Care and a single national formulary. The proposed model positions the community pharmacist in a protagonist role in the pharmacotherapeutic safety of older adults.
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