Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care

Background: regular medication review has been recommended for those over 7 5 and those on multiple drug therapy. Pharmacists arc a potential source of assistance in reviewing medication. Evidence of the benefits of this proce ss is needed. Objective: to study the effect of medication review led by a pharmacist on resolution of pharmaceutical care issues, medicine costs, use of health and social services and health-related quality of life. Design: randomized, controlled trial. Setting: general medical practices in the Grampian region of Scotland. Subjects: patients aged at least 65 years, with at least two chronic diseas e states who were taking at least four prescribed medicines regularly. Methods: pharmacists reviewed the drug therapy of 332 patients, using infor mation obtained from the practice computer, medical records and patient int erviews. In 168 patients, a pharmaceutical care plan was then drawn up and implemented. The 164 control patients continued to receive normal care. All outcome measures were assessed at baseline and after 3 months. Results: all patients had at least two pharmaceutical care issues at baseli ne. Half of these were identified from the prescription record, the rest fr om notes and patient interview. Of all the issues, 21% were resolved by inf ormation found in notes and 8.5% by Patient interview. General practitioner s agreed with 96% of all care issues documented on the care plans in the in tervention group. At the time of follow-up, 70% of the remaining care issue s had been resolved in the intervention group, while only 14% had been reso lved in the control group. There were no changes in medicine costs or healt h-related quality of life in either group. There were small increases in co ntacts with health-care professionals and slightly fewer hospital admission s among the intervention group than the control group. Conclusions: pharmacist-led medication review has the capacity to identify and resolve pharmaceutical care issues and may have some impact on the use of other health services.