Treatment reviews of older people on polypharmacy in primary care: cluster controlled trial comparing two approaches

Abstract

Background: Older people are prone to problems related to use of medicines. As they tend to use many different medicines, monitoring pharmacotherapy for older people in primary care is important.

Aim: To determine which procedure for treatment reviews (case conferences versus written feedback) results in more medication changes, measured at different moments in time. To determine the costs and savings related to such an intervention.

Design of study: Randomised, controlled trial, randomisation at the level of the community pharmacy.

Setting: Primary care; treatment reviews were performed by 28 pharmacists and 77 GPs concerning 738 older people (> or =75 years) on polypharmacy (>five medicines).

Method: In one group, pharmacists and GPs performed case conferences on prescription-related problems; in the other group, pharmacists provided results of a treatment review to GPs as written feedback. Number of medication changes was counted following clinically-relevant recommendations. Costs and savings associated with the intervention at various times were calculated.

Results: In the case-conference group significantly more medication changes were initiated (42 versus 22, P = 0.02). This difference was also present 6 months after treatment reviews (36 versus 19, P = 0.02). Nine months after treatment reviews, the difference was no longer significant (33 versus 19, P = 0.07). Additional costs in the case-conference group seem to be covered by the slightly greater savings in this group.

Conclusion: Performing treatment reviews with case conferences leads to greater uptake of clinically-relevant recommendations. Extra costs seem to be covered by related savings. The effect of the intervention declines over time, so performing treatment reviews for older people should be integrated in the routine collaboration between GPs and pharmacists.

Figures

Figure 1

Flow diagram of the intervention study comparing two procedures for medication reviews of older people on polypharmacy in primary care.