Skip to main content

Advertisement

SpringerLink
Log in

Medication reviews in primary care in Sweden: importance of clinical pharmacists’ recommendations on drug-related problems

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background One way of preventing and solving drug-related problems in frail elderly is to perform team-based medication reviews. Objective To evaluate the quality of the clinical pharmacy service to primary care using structured medication reviews, focusing on the clinical significance of the recommendations made by clinical pharmacists. Setting A random sample of 150 patients (out of 1541) who received structured team based medication reviews. The patients lived at a geriatric nursing home or were ≥65 years and lived in ordinary housing with medication-related community help. Method Based on information on symptoms, kidney function, blood pressure, diagnoses and the medication list, a pharmacist identified possible drug-related problems and supplied recommendations for the general practitioner to act on. Two independent physicians retrospectively ranked the clinical significance of the recommendations according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Main outcome measure The clinical significance of the recommendations. Results In total 349 drug-related problems were identified, leading to recommendations. The vast majority of the recommendations (96 %) were judged to have significance 3 or higher and more than the half were judged to have significance 4 or higher. Conclusion The high proportion of clinically significant recommendations provided by pharmacists when performing team-based medication reviews suggest that these clinical pharmacy services have potential to increase prescribing quality. As such, the medication reviews have the potential for contributing to a better and safer drug therapy for elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hovstadius B, Hovstadius K, Astrand B, Petersson G. Increasing polypharmacy—an individual-based study of the Swedish population 2005–2008. BMC Clin Pharmacol. 2010;10:16.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug–drug interactions: population database analysis 1995–2010. BMC Med. 2015;13:74.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Turnheim K. Drug therapy in the elderly. Exp Gerontol. 2004;39(11–12):1731–8.

    Article  CAS  PubMed  Google Scholar 

  4. Seymour RM, Routledge PA. Important drug–drug interactions in the elderly. Drugs Aging. 1998;12(6):485–94.

    Article  CAS  PubMed  Google Scholar 

  5. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. Dicp. 1990;24(11):1093–7.

    CAS  PubMed  Google Scholar 

  6. Fryckstedt J, Asker-Hagelberg C. 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(12–13):894–8.

    PubMed  Google Scholar 

  7. Mjorndal T, Boman MD, Hagg S, Backstrom M, Wiholm BE, Wahlin A, Dahlqvist R. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf. 2002;11(1):65–72.

    Article  PubMed  Google Scholar 

  8. Paul E, End-Rodrigues T, Thylen P, Bergman U. Adverse drug reactions a common cause of hospitalization of the elderly. A clinical retrospective study. Lakartidningen. 2008;105(35):2338–42.

    PubMed  Google Scholar 

  9. Patel P, Zed PJ. Drug-related visits to the emergency department: how big is the problem? Pharmacotherapy. 2002;22(7):915–23.

    Article  PubMed  Google Scholar 

  10. Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46–54.

    Article  CAS  PubMed  Google Scholar 

  11. Hellstrom LM, Bondesson A, Hoglund P, Midlov P, Holmdahl L, Rickhag E, Eriksson T. 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.

    Article  PubMed  Google Scholar 

  12. Milos V, Rekman E, Bondesson A, Eriksson T, Jakobsson U, Westerlund T, Midlov P. Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: a randomised controlled study. Drugs Aging. 2013;30(4):235–46.

    Article  CAS  PubMed  Google Scholar 

  13. Bondesson A, Holmdahl L, Midlov P, Hoglund P, Andersson E, Eriksson T. Acceptance and importance of clinical pharmacists’ LIMM-based recommendations. Int J Clin Pharm. 2012;34(2):272–6.

    Article  PubMed  Google Scholar 

  14. Hedström M, Lidström B, Hulter Åsberg K. PHASE-20: a new instrument for assessment of possible therapeutic drug-related symptoms among elderly in nursing homes. Nord J Nurs Res Clin Stud. 2009;4:9–14.

    Article  Google Scholar 

  15. Indicators for evaluation of the quality of drug use by elderly. Stockholm: The National Board of Health and Welfare; 2003, updated 2010. Report No.: 2010-6-29.

  16. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: The McGraw-Hill Companies Inc; 1998. ISBN 978-0070120464.

    Google Scholar 

  17. Hatoum HT, Hutchinson RA, Witte KW, Newby GP. Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction. Drug Intell Clin Pharm. 1988;22(3):252–9.

    CAS  PubMed  Google Scholar 

  18. Perera PN, Guy MC, Sweaney AM, Boesen KP. Evaluation of prescriber responses to pharmacist recommendations communicated by fax in a medication therapy management program (MTMP). J Manag Care Pharm. 2011;17(5):345–54.

    PubMed  PubMed Central  Google Scholar 

  19. Kwint HF, Faber A, Gussekloo J, Bouvy ML. Effects of medication review on drug-related problems in patients using automated drug-dispensing systems: a pragmatic randomized controlled study. Drugs Aging. 2011;28(4):305–14.

    Article  PubMed  Google Scholar 

  20. Vinks TH, Egberts TC, de Lange TM, de Koning FH. Pharmacist-based medication review reduces potential drug-related problems in the elderly: the SMOG controlled trial. Drugs Aging. 2009;26(2):123–33.

    Article  CAS  PubMed  Google Scholar 

  21. Hilmer SN, Gnjidic D, Le Couteur DG. Thinking through the medication list—appropriate prescribing and deprescribing in robust and frail older patients. Aust Fam Physician. 2012;41(12):924–8.

    PubMed  Google Scholar 

  22. Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol. 2004;57(2):121–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The assistance of Martin Svahn, Master’s student in Clinical Pharmacy, Uppsala University, who helped with the compilation of data, is acknowledged.

Funding

The Department of Medicines Management and Informatics, Region Skåne, Sweden funded the study.

Conflicts of interest

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden

    Sara Modig & Åsa Bondesson

  2. Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Malmö, Sweden

    Sara Modig

  3. Department of Medicine, Lund University Hospital, Lund, Sweden

    Lydia Holmdahl

  4. Department of Laboratory Medicine/Clinical Pharmacology, Lund University, Lund, Sweden

    Åsa Bondesson

Authors
  1. Sara Modig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lydia Holmdahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Åsa Bondesson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara Modig.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Modig, S., Holmdahl, L. & Bondesson, Å. Medication reviews in primary care in Sweden: importance of clinical pharmacists’ recommendations on drug-related problems. Int J Clin Pharm 38, 41–45 (2016). https://doi.org/10.1007/s11096-015-0189-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-015-0189-x

Keywords

Search

Navigation