Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice

Objective To determine whether a pharmacist can effectively review repeat p rescriptions through consultations with elderly patients in general practic e. Design Randomised controlled trial comparing clinical medication review by a pharmacist against normal general practice review. Setting Four general practices. Participants 1188 patients aged 65 or over who were receiving at least one repeat prescription and living in the community. Intervention Patients were invited to a consultation at which the pharmacis t reviewed their medical conditions and current treatment. Main outcome measures Number of changes to repeat prescriptions over one ye ar, drug costs, and use of healthcare services. Results 590 (97%) patients in the intervention group were reviewed compared with 233 (44%) in the control group. Patients seen by the pharmacist were more likely to have changes made to their repeat prescriptions (mean number of changes per patient 2.2 v 1.9; difference = 0.31, 95% confidence interv al 0.06 to 0.57; P = 0.02). Monthly drug costs rose in both groups over the year, but the rise was less in the intervention group (mean difference pou nd4.72 per 28 days, -pound7.04 to -pound2.41); equivalent to pound 61 per p atient a year. Intervention patients had a smaller rise in the number of dr ugs prescribed (0.2 v 0.4; mean difference -0.2, -0.4 to -0.1). there was n o evidence that review of treatment by the pharmacist affected practice con sultation rates, outpatient consultations, hospital admissions, or death ra te. Conclusions A clinical pharmacist can conduct effective consultations with elderly patients in general practice to review their drugs. Such review res ults in significant changes in patients' drugs and saves more than the cost of the intervention without affecting the workload of general practitioner s.