[A review of the medication in polymedicated elderly with vascular risk: a randomised controlled trial]

Abstract

Objective: To analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease.

Design: A randomised controlled trial with blind evaluation.

Setting: Fourteen Primary Health Care centres in Andalusia

Participants: A total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease.

Intervention: A pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care.

Main measurements: Percentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA(1c), and quality of life scores.

Results: A total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051).

Conclusion: Clinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found.

Copyright © 2011 Elsevier España, S.L. All rights reserved.

Figures

Esquema general del estudio. Estudio aleatorizado y controlado en pacientes mayores de 65 años, polimedicados y con criterios de entrada al Proceso Asistencial Integrado Riesgo Vascular que tiene como objetivo valorar la efectividad de una intervención basada en la revisión de la medicación en la mejora de la adecuación de los tratamientos y el control de determinadas de variables del Proceso, en comparación con la asistencia sanitaria habitual.