Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study
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Polypharmacy in the Swedish elderly population is currently a prioritised area of research with a focus on reducing the use of potentially inappropriate medications (PIMs). Multi-professional interventions have previously been tested for their ability to improve drug therapy in frail elderly patients.
This study aimed to assess a structured model for pharmacist-led medication reviews in primary health care in southern Sweden and to measure its effects on numbers of patients with PIMs (using the definition of the Swedish National Board of Health and Welfare) using ≥10 drugs and using ≥3 psychotropics.
This study was a randomised controlled clinical trial performed in a group of patients aged ≥75 years and living in nursing homes or the community and receiving municipal health care. Medication reviews were performed by trained clinical pharmacists based on nurse-initiated symptom assessments with team-based or distance feedback to the physician. Data were collected from the patients’ electronic medication lists and medical records at baseline and 2 months after the medication review.
A total of 369 patients were included: 182 in the intervention group and 187 in the control group. One-third of the patients in both groups had at least one PIM at baseline. Two months after the medication reviews, the number of intervention group patients with at least one PIM and the number of intervention group patients using ten or more drugs had decreased (p = 0.007 and p = 0.001, respectively), while there were no statistically significant changes in the control patients. No changes were seen in the number of patients using three or more psychotropic drugs, although the dosages of these drugs tended to decrease. Drug-related problems (DRPs) were identified in 93 % of the 182 patients in the intervention group. In total, there were 431 DRPs in the intervention group (a mean of 2.5 DRPs per patient, range 0–9, SD 1.5 at 95 % CI) and 16 % of the DRPs were related to PIMs.
Medication reviews involving pharmacists in primary health care appear to be a feasible method to reduce the number of patients with PIMs, thus improving the quality of pharmacotherapy in elderly patients.
- Shi S, Morike K, Klotz U. The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol. 2008;64(2):183–99. CrossRef
- Noble RE. Drug therapy in the elderly. Metabolism. 2003;52(10 Suppl 2):27–30. CrossRef
- Midlov P, Eriksson T, Kragh A. Drug-related problems in the elderly [online] Chapter 1, Aging and Drugs 2009: 4. Available from URL: http://www.springerlink.com.ludwig.lub.lu.se [Accessed 2012 Nov 19].
- Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51. CrossRef
- Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24(11):1093–7.
- American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. CrossRef
- The Swedish National Board of Health and Welfare. Indikatorer för god läkemedelsterapi hos äldre (publication no.: 2010-6-29) [in Swedish]. Available from URL: http://www.socialstyrelsen.se [Accessed 2012 Nov 16].
- Johnell K, Fastbom J. Multi-dose drug dispensing and inappropriate drug use: a nationwide register-based study of over 700,000 elderly. Scand J Prim Health Care. 2008;26(2):86–91. CrossRef
- Ruths S, Straand J, Nygaard HA. Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study. Qual Saf Health Care. 2003;12(3):176–80. CrossRef
- Midlov P, Bondesson A, Eriksson T, et al. Effects of educational outreach visits on prescribing of benzodiazepines and antipsychotic drugs to elderly patients in primary health care in southern Sweden. Fam Pract. 2006;23(1):60–4. CrossRef
- Midlov P, Deierborg E, Holmdahl L, et al. Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital. Pharm World Sci. 2008;30(6):840–5. CrossRef
- Bernsten C, Bjorkman I, Caramona M, et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging. 2001;18(1):63–77. CrossRef
- Pharmaceutical Care Network Europe. PCNE Guidelines for Retrospective Medication Review in Pharmacy V0, The official PCNE definition 2012. Available from: http://www.pcne.org 2012 [Accessed 2012 June 15].
- Westerlund T, Marklund B. Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J Clin Pharm Ther. 2009;34(3):319–27. CrossRef
- Roberts MS, Stokes JA, King MA, et al. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol. 2001;51(3):257–65. CrossRef
- Brulhart MI, Wermeille JP. Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes. Int J Clin Pharm. 2011;33(3):549–57. CrossRef
- Kragh A. Two out of three persons living in nursing homes for the elderly are treated with at least ten different drugs. A survey of drug prescriptions in the northeastern part of Skane [in Swedish]. Lakartidningen. 2004;101(11): 994–6, 9.
- Hellstrom LM, Bondesson A, Hoglund P, et al. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol. 2011;67(7):741–52. CrossRef
- Schmidt I, Claesson CB, Westerholm B, et al. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. J Am Geriatr Soc. 1998;46(1):77–82.
- Hedström MLB, Hulter Åsberg K. PHASE-20: a new instrument for assessment of possible therapeutic drug-related symptoms among elderly in nursing homes [in Swedish]. Nord J Nurs Res Clin Stud/Vård i Norden. 2009;29(4):9–14.
- Anatomical Therapeutic Chemical Classification System [online]. Available from URL: http://www.who.int/classifications/atcddd/en/ [Accessed 2012 6th June].
- Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: McGraw-Hill; 1998.
- Bennett DA. How can I deal with missing data in my study? Aust N Z J Public Health. 2001;25(5):464–9.
- Crotty M, Halbert J, Rowett D, et al. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age Ageing. 2004;33(6):612–7. CrossRef
- Davidsson M, Vibe OE, Ruths S, et al. A multidisciplinary approach to improve drug therapy in nursing homes. J Multidiscip Healthc. 2011;4:9–13.
- Liu GG, Christensen DB. The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc (Wash). 2002;42(6):847–57. CrossRef
- Finkers F, Maring JG, Boersma F, et al. A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting. J Clin Pharm Ther. 2007;32(5):469–76. CrossRef
- Higashi T, Shekelle PG, Solomon DH, et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med. 2004;140(9):714–20. CrossRef
- Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516–23. CrossRef
- Meredith S, Feldman P, Frey D, et al. Improving medication use in newly admitted home healthcare patients: a randomized controlled trial. J Am Geriatr Soc. 2002;50(9):1484–91. CrossRef
- Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173–84. CrossRef
- Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet. 2007;370(9582):185–91. CrossRef
- Holland R, Desborough J, Goodyer L, et al. 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(3):303–16. CrossRef
- Gallagher P, Barry P, Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32(2):113–21. CrossRef
- Bondesson A, Holmdahl L, Midlov P, et al. Acceptance and importance of clinical pharmacists’ LIMM-based recommendations. Int J Clin Pharm. 2012;34(2):272–6. CrossRef
- Bergkvist Christensen A, Holmbjer L, et al. The process of identifying, solving and preventing drug related problems in the LIMM-study. Int J Clin Pharm. 2011;33(6):1010–8. CrossRef
- Zermansky AG, Alldred DP, Petty DR, et al. Clinical medication review by a pharmacist of elderly people living in care homes—randomised controlled trial. Age Ageing. 2006;35(6):586–91. CrossRef
- Stuijt CC, Franssen EJ, Egberts AC, et al. Appropriateness of prescribing among elderly patients in a Dutch residential home: observational study of outcomes after a pharmacist-led medication review. Drugs Aging. 2008;25(11):947–54. CrossRef
- Halvorsen KH, Ruths S, Granas AG, et al. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scand J Prim Health Care. 2010;28(2):82–8. CrossRef
- Chen TF, de Almeida Neto AC. Exploring elements of interprofessional collaboration between pharmacists and physicians in medication review. Pharm World Sci. 2007;29(6):574–6. CrossRef
- de Almeida Neto AC, Chen TF. When pharmacotherapeutic recommendations may lead to the reverse effect on physician decision-making. Pharm World Sci. 2008;30(1):3–8. CrossRef
- Bernabei R, Gambassi G, Lapane K, et al. Characteristics of the SAGE database: a new resource for research on outcomes in long-term care. SAGE (Systematic Assessment of Geriatric drug use via Epidemiology) Study Group. J Gerontol A Biol Sci Med Sci. 1999;54(1):M25–33. CrossRef
- Kragh A, Rekman E. Remote drug-review for better use of pharmaceuticals among the elderly [in Swedish]. Lakartidningen. 2005;102(15):1143, 5–6, 9.
- Holland R, Smith R, Harvey I. Where now for pharmacist led medication review? J Epidemiol Community Health. 2006;60(2):92–3. CrossRef
- Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study
Drugs & Aging
Volume 30, Issue 4 , pp 235-246
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- Author Affiliations
- 1. Laröd Health Care Centre, Helsingborg, Sweden
- 2. Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden
- 9. Faculty of Medicine, Lund University Department of Clinical Sciences Malmö Clinical Research Centre (CRC), Building 28, Floor 11, Jan Waldenströms gata 35, Skåne University Hospital, 205 02, Malmö, Sweden
- 3. Brösarp Health Care Centre, Brösarp, Sweden
- 4. Department of Medicines Management and Informatics, Kristianstad, Region Skåne, Sweden
- 5. Clinical Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden
- 6. Apoteket Farmaci AB, Stockholm, Sweden
- 7. Medical Products Agency, Department of Rational Use of Medicines, Uppsala, Sweden
- 8. Sahlgrenska Academy, Institute of Medicine, Department of Public Health and Community Medicine, Unit of Social Medicine, University of Gothenburg, Gothenburg, Sweden