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 75 and those on multiple drug therapy. Pharmacists arc a potential source of assistance in reviewing medication. Evidence of the benefits of this process 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 disease states who were taking at least four prescribed medicines regularly. Methods: pharmacists reviewed the drug therapy of 332 patients, using information obtained from the practice computer, medical records and patient interviews. 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 baseline. Half of these were identified from the prescription record, the rest from notes and patient interview. Of all the issues, 21% were resolved by information found in notes and 8.5% by Patient interview. General practitioners agreed with 96% of all care issues documented on the care plans in the intervention group. At the time of follow-up, 70% of the remaining care issues had been resolved in the intervention group, while only 14% had been resolved in the control group. There were no changes in medicine costs or health-related quality of life in either group. There were small increases in contacts with health-care professionals and slightly fewer hospital admissions 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.