Advertisement

International Journal of Clinical Pharmacy

, Volume 37, Issue 5, pp 931–940 | Cite as

Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes

  • Carla Castrillon Ocampo
  • Victoria Garcia-CardenasEmail author
  • Fernando Martinez-Martinez
  • Shalom I. Benrimoj
  • Pedro Amariles
  • Miguel Angel Gastelurrutia
Research Article

Abstract

Background Despite many research studies demonstrating the benefit in clinical, economic, and humanistic outcomes of professional pharmacy services, there is a paucity of evidence when these services become incorporated into the usual practice of a community pharmacy. Objective The objective of the present study was to evaluate the clinical, economic, and humanistic impact of a pharmacist-conducted medication review with follow-up following 18 months implementation. Setting Community pharmacies in Spain. Method The study used an effectiveness-implementation hybrid design. During the follow-up, patients attended the pharmacy on a monthly basis and received the medication review with follow-up service. Main outcome measure Economic, clinical, and humanistic measures were used to assess the impact of the service. Results 132 patients received the service. During the 18 months of follow-up, 408 negative outcomes related to medicines (which are uncontrolled health problems) were identified, of which 393 were resolved. The average number of medicines used by patients significantly decreased from 6.1 (SD: 2.9) to 3.3 (SD: 2.2). A significant decrease was also observed in hospitalizations [OR = 0.31 (IC 95 % = 0.10–0.99)] and in emergency department visits [OR = 0.16 (IC 95 % = 0.05–0.55); p = 0.001]. A general trend to increase all quality of life domains was observed over time. The higher increase was observed in the construct health transition [mean increase: 30.7 (SD: 25.4)], followed by bodily pain [mean increase: 22.3 (SD: 25.4)], and general health [mean increase: 20.7 (SD: 23.7)]. Medication knowledge significantly increased in terms of aggregated domains of dose, frequency, drug indication [from 8.9 (SD: 17.5) to 87.9 (SD: 25.0)], and dose and frequency [from 9.3 (SD: 17.9) to 92.5 (22.1)]. Although a slight improvement was observed in terms of drug indication, this increase was not statistically significant. 68 out of 132 patients (51.5 %) were non-adherent to their treatment. This number decreased to 1 (0.8 %) after the follow-up [OR = 0.007 (IC 95 %: 0.001–0.053) p < 0.001]. Conclusion A community pharmacy based medication review with follow-up service delivered by a trained pharmacist, has positive effects across clinical, economic, and humanistic outcomes. These results are consistent with previous studies. Incorporating community pharmacists into the multidisciplinary team is a reliable solution to improve health care.

Keywords

Community pharmacy Drug-related problems Implementation research Medication review Negative outcomes Pharmaceutical care Professional pharmacy services Spain 

Notes

Funding

This work was financially supported by the participant pharmacy. No external funding was provided.

Conflicts of interest

All the authors have declared that they have no conflict of interest.

References

  1. 1.
    World Health Organization. The world health report: primary health care now more than ever. Switzerland: World Health Organization; 2008 (cited 2014 Jan 20) (ISBN: 9789241563734). http://www.who.int/whr/2008/whr08_en.pdf.
  2. 2.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155(18):1949–56.CrossRefPubMedGoogle Scholar
  4. 4.
    Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192–9.Google Scholar
  5. 5.
    American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: core elements of an MTM service model (internet). 2008 March (cited 2015 Jan 30). http://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf.
  6. 6.
    Pharmaceutical Society of Australia. Guidelines for pharmacists providing home medicines review (HMR) services (internet). 2011 Oct (cited 2015 Feb 24). http://www.psa.org.au/download/practice-guidelines/home-medicines-review-services.pdf.
  7. 7.
    Ontario Ministry of Health and Long-Term Care. MedsCheck program standarization and system requirements (internet). 2012 Jan (cited 2015 Jan 22). http://www.health.gov.on.ca/en/pro/programs/drugs/medscheck/standards.aspx.
  8. 8.
    Pharmacy Council of New Zealand. Medicines management: definition, levels, competence framework (Internet). 2006 July (cited 2015 Feb 24). http://www.pharmacycouncil.org.nz/cms_show_download.php?id=124.
  9. 9.
    Pharmaceutical Care Forum. Expert pannel. Consensus document. Madrid: General Councill of Spanish Pharmacists; 2010 (cited 2015 Feb 19) (ISBN: 9788469112434). http://www.portalfarma.com/inicio/atencionfarmaceutica/forodeattfarma/Documents/DocumentodeConsensodeForo2008.pdf.
  10. 10.
    Sabater Hernández D, Silva Castro M, Faus Dáder M. Dader method. Medication review with follow up guideliness. 3rd ed. Granada: Pharmaceutical Care Research Group; 2007.Google Scholar
  11. 11.
    Bunting BA, Cranor CW. The Asheville project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma. J Am Pharm Assoc. 2006;46(2):133–47.CrossRefGoogle Scholar
  12. 12.
    Bunting BA, Smith BH, Sutherland SE. The Asheville project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc. 2008;48(1):23–31.CrossRefGoogle Scholar
  13. 13.
    Cranor CW, Christensen DB. The Asheville project: short-term outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):149–59.CrossRefGoogle Scholar
  14. 14.
    Westfall JM, Mold J, Fagnan L. Practice-based research—“Blue Highways” on the NIH roadmap. JAMA. 2007;297(4):403–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Martinez-Martinez F, Farragher T, Faus M, Garcia-Cardenas V, Gastelurrutia M, Jodar F. Clinical, economic and humanistic outcomes of medication review with follow-up in aged polypharmacy patients in the Spanish community pharmacy. Madrid: General Council of Spanish Pharmacists; 2014 (cited 2015 Feb 18) (ISBN: 9788487276835). http://www.pharmaceutical-care.org/archivos/992/V2-Resultados-Definitivos-Programa-Consigue-Impacto-2011-2014.pdf.
  17. 17.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569–82.CrossRefPubMedGoogle Scholar
  18. 18.
    Saez-Benito L, Fernandez-Llimos F, Feletto E, Gastelurrutia MA, Martinez-Martinez F, Benrimoj SI. Evidence of the clinical effectiveness of cognitive pharmaceutical services for aged patients. Age Ageing. 2013;42(4):442–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41(11):1770–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Machado M, Nassor N, Bajcar JM, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother. 2008;42(9):1195–207.CrossRefPubMedGoogle Scholar
  21. 21.
    Amariles P, Sabater-Hernandez D, Garcia-Jimenez E, Rodriguez-Chamorro MA, Prats-Mas R, Marin-Magan F, et al. Effectiveness of Dader Method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial. J Manag Care Pharm. 2012;18(4):311–23.PubMedGoogle Scholar
  22. 22.
    Institute of Medicine. Preventing medication errors. 1st ed. Washington DC: The National Academies Press; 2007. ISBN 9780309101479.Google Scholar
  23. 23.
    Lee JK, Slack MK, Martin J, Ehrman C, Chisholm-Burns M. Geriatric patient care by U.S. pharmacists in healthcare teams: systematic review and meta-analyses. J Am Geriatr Soc. 2013;61(7):1119–27.CrossRefPubMedGoogle Scholar
  24. 24.
    Jodar-Sanchez F, Malet-Larrea A, Martin JJ, Garcia-Mochon L, Lopez Del Amo MP, Martinez-Martinez F, et al. Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in Spain: The conSIGUE Program. Pharmacoeconomics. 2015.Google Scholar
  25. 25.
    Baena MI, Fajardo PC, Pintor-Marmol A, Faus MJ, Marin R, Zarzuelo A, et al. Negative clinical outcomes of medication resulting in emergency department visits. Eur J Clin Pharmacol. 2014;70(1):79–87.CrossRefPubMedGoogle Scholar
  26. 26.
    Baena MI, Faus MJ, Fajardo PC, Luque FM, Sierra F, Martinez-Olmos J, et al. Medicine-related problems resulting in emergency department visits. Eur J Clin Pharmacol. 2006;62(5):387–93.CrossRefPubMedGoogle Scholar
  27. 27.
    Hepler C, Strand L. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.PubMedGoogle Scholar
  28. 28.
    Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Medical Research Council (MRC). Developing and evaluating complex interventions: a new guidance. London: Medical Research Council (cited 2015 Feb 20). http://www.mrc.ac.uk/documents/pdf/complex-interventions-guidance/.
  30. 30.
    Vilagut G, Ferrer M, Rajmil L, Rebollo P, Permanyer-Miralda G, Quintana JM, et al. El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos. Gac Sanit. 2005;19:135–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholz CD, Mukherjee J. Can simple clinical measurements detect patient noncompliance? Hypertension. 1980;2(6):757–64.CrossRefPubMedGoogle Scholar
  32. 32.
    Lim WS, Low HN, Chan SP, Chen HN, Ding YY, Tan TL. Impact of a pharmacist consult clinic on a hospital-based geriatric outpatient clinic in Singapore. Ann Acad Med Singapore. 2004;33(2):220–7.PubMedGoogle Scholar
  33. 33.
    Cipolle R, Strand L, Morley P. Pharmaceutical care practice. 1st ed. New York: McGraw-Hill; 1998. ISBN 9780070120464.Google Scholar
  34. 34.
    Gastelurrutia P, Benrimoj SI, Espejo J, Tuneu L, Mangues MA, Bayes-Genis A. Negative clinical outcomes associated with drug-related problems in heart failure (HF) outpatients: impact of a pharmacist in a multidisciplinary HF clinic. J Card Fail. 2011;17(3):217–23.CrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Carla Castrillon Ocampo
    • 1
  • Victoria Garcia-Cardenas
    • 1
    • 2
    Email author
  • Fernando Martinez-Martinez
    • 1
  • Shalom I. Benrimoj
    • 2
  • Pedro Amariles
    • 3
  • Miguel Angel Gastelurrutia
    • 1
  1. 1.Grupo de Investigacion en Atencion Farmaceutica, Facultad de FarmaciaUniversidad de GranadaGranadaSpain
  2. 2.Graduate School of HealthUniversity of Technology SydneySydneyAustralia
  3. 3.Grupo Promoción y Prevención Farmacéutica, Departamento de FarmaciaUniversidad de Antioquia UdeAMedellínColombia

Personalised recommendations