Effects of a pharmacist-led structured medication review in primary care on drug-related problems and hospital admission rates: a randomized controlled trial

Cecilia Lenander, Birgitta Elfsson, Birgitta Danielsson, Patrik Midlöv, Jan Hasselström, Cecilia Lenander, Birgitta Elfsson, Birgitta Danielsson, Patrik Midlöv, Jan Hasselström

Abstract

Objective: To determine whether a pharmacist-led medications review in primary care reduces the number of drugs and the number of drug-related problems.

Design: Prospective randomized controlled trial.

Setting: Liljeholmen Primary Care Centre, Stockholm, Sweden.

Subjects: 209 patients aged ≥ 65 years with five or more different medications. Intervention. Patients answered a questionnaire regarding medications. The pharmacist reviewed all medications (prescription, non-prescription, and herbal) regarding recommendations and renal impairment, giving advice to patients and GPs. Each patient met the pharmacist before seeing their GP. Control patients received their usual care.

Main outcome measures: Drug-related problems and number of drugs. Secondary outcomes included health care utilization and self-rated health during 12 months of follow-up.

Results: No significant difference was seen when comparing change in drug-related problems between the groups. However, a significant decrease in drug-related problems was observed in the intervention group (from 1.73 per patient at baseline to 1.31 at follow-up, p < 0.05). The change in number of drugs was more pronounced in the intervention group (p < 0.046). Intervention group patients were not admitted to hospital on fewer occasions or for fewer days, and there was no significant difference between the two groups regarding utilization of primary care during follow-up. Self-rated health remained unchanged in the intervention group, whereas a drop (p < 0.02) was reported in the control group. This resulted in a significant difference in change in self-rated health between the groups (p < 0.047).

Conclusions: The addition of a skilled pharmacist to the primary care team may contribute to reductions in numbers of drugs and maintenance of self-rated health in elderly patients with polypharmacy.

Keywords: Drug-related problems; Sweden; elderly; general practice; medication review; pharmacist; primary care.

Figures

Figure 1.
Figure 1.
Overview of study design, patient inclusion, and completion of questionnaires.
Figure 2.
Figure 2.
Primary care visits and hospital admissions (number and duration in days) recorded in the control and intervention groups during one year. Data are shown as the median (♦) with 95% CI (▬) and mean (■) values. None of the investigated parameters showed a statistically significant difference. n = 141 patients (75 in the intervention group and 66 in the control group).

References

    1. Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): A meta-analysis of observational studies. Pharm World Sci. 2002;24:46–54.
    1. Fryckstedt J, Asker-Hagelberg C. Lakemedelsrelaterade problem vanliga pa medicinakuten. Orsak till inlaggning hos nastan var tredje patient, enligt kvalitetsuppfoljning [Drug-related problems common in the emergency department of internal medicine: The cause of admission in almost every third patient according to quality follow-up] Lakartidningen. 2008;105:894–8.
    1. Odar-Cederlof I, Oskarsson P, Ohlen G, Tesfa Y, Bergendal A, Hellden A, et al. Lakemedelsbiverkan som orsak till inlaggning pa sjukhus. Vanliga medel star for merparten, visar tvarsnittsstudie [Adverse drug effect as cause of hospital admission: Common drugs are the major part according to the cross-sectional study] Lakartidningen. 2008;105:890–3.
    1. Bakken MS, Ranhoff AH, Engeland A, Ruths S. Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards. Scand J Prim Health Care. 2012;30:169–75.
    1. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.
    1. Swedish Council on Health Technology Assessment. Stockholm: Statens beredning för medicinsk utvärdering; 2009. Äldres läkemedelsanvändning: hur kan den förbättras?: en systematisk litteraturöversikt [Use of medications in elderly: how can it be improved? A systematic litterature review]
    1. Swedish National Board of Health and Welfare. Stockholm: Socialstyrelsens förlag; 2003. Indikatorer för utvärdering av läkemedelsanvändningens kvalitet hos äldre [Indicators for the evaluation of quality in drug use of the elderly]
    1. Bjornson DC, Hiner WO, Jr., Potyk RP, Nelson BA, Lombardo FA, Morton TA, et al. Effect of pharmacists on health care outcomes in hospitalized patients. Am J Hosp Pharm. 1993;50:1875–84.
    1. Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: A systematic review of randomized trials. Arch Intern Med. 2008;168:687–94.
    1. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: A randomized controlled trial. Arch Intern Med. 2009;169:894–900.
    1. Lidstrom B, Levol R, Sidenvall B, Agnarsson I. Läkemedelsgenomgångar vid särskilda boenden i Uppsala län [Medication review at assisted living facilities in Uppsala] FoU- Centrum äldre i Uppsala län. 2003
    1. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: How well can it be measured and optimised? Lancet. 2007;370:173–84.
    1. Jameson J, VanNoord G, Vanderwoud K. The impact of a pharmacotherapy consultation on the cost and outcome of medical therapy. J Fam Pract. 1995;41:469–72.
    1. Sellors J, Kaczorowski J, Sellors C, Dolovich L, Woodward C, Willan A, et al. A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients. CMAJ. 2003;169:17–22.
    1. Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, Lowe CJ. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ. 2001;323:1340–3.
    1. Royal S, Smeaton L, Avery AJ, Hurwitz B, Sheikh A. Interventions in primary care to reduce medication related adverse events and hospital admissions: Systematic review and meta-analysis. Qual Saf Health Care. 2006;15:23–31.
    1. Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol. 2008;65:303–16.
    1. Holland R, Lenaghan E, Harvey I, Smith R, Shepstone L, Lipp A, et al. Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. BMJ. 2005;330:293.
    1. Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS. Medication reviews in the community: Results of a randomized, controlled effectiveness trial. Br J Clin Pharmacol. 2004;58:648–64.
    1. Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: Effects on health services utilisation, costs, and patient outcomes. Cochrane Database Syst Rev. 2000 CD000336.
    1. Godman B, Wettermark B, Hoffmann M, Andersson K, Haycox A, Gustafsson LL. Multifaceted national and regional drug reforms and initiatives in ambulatory care in Sweden: Global relevance. Expert Review Pharmacoeconomics & Outcomes Res. 2009;9:65–83.
    1. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: An update. Arch Intern Med. 1997;157:1531–6.
    1. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24:1093–7. Epub 1990/11/01.
    1. Eriksson I, Unden AL, Elofsson S. Self-rated health. Comparisons between three different measures: Results from a population study. Int J Epidemiol. 2001;30:326–33.
    1. Milos V, Rekman E, Bondesson A, Eriksson T, Jakobsson U, Westerlund T, et al. Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: A randomised controlled study. Drugs Aging. 2013;30:235–46.
    1. Lenaghan E, Holland R, Brooks A. Home-based medication review in a high risk elderly population in primary care: The POLYMED randomised controlled trial. Age Ageing. 2007;36:292–7.
    1. Blix HS, Viktil KK, Moger TA, Reikvam A. Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams. Pharm World Sci. 2006;28:152–8.
    1. Bergkvist Christensen A, Holmbjer L, Midlov P, Hoglund P, Larsson L, Bondesson A, et al. The process of identifying, solving and preventing drug related problems in the LIMM study. Int J Clin Pharm. 2011;33:1010–18.
    1. Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PR, et al. Pharmacist-led medication review in patients over 65: A randomized, controlled trial in primary care. Age Ageing. 2001;30:205–11.
    1. Pacini M, Smith RD, Wilson EC, Holland R. Home-based medication review in older people: Is it cost effective? PharmacoEconomics. 2007;25:171–80.

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