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.
KeywordsNursing Home Medication Review Medication List Nursing Home Patient Provide Home Care
The authors especially want to thank the four pharmacists who performed the medication reviews (Annika Dobszai, Karin Fält, Martina Haggren and Krister Karlsson), the pharmacist student who initially collected the data (Susan Wong) and the municipal care nurses. We are indebted to Stephen Gilliver for his expertise and invaluable advice in proofreading the manuscript.
Conflict of interest
The opinions or assertions in this article are the views of the authors and are not to be construed as official or as necessarily reflecting the views of the Swedish Medical Products Agency, where one of the authors is employed.
The study was conducted with government funding for projects involving improvement of drug therapy in the elderly.
- 3.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].
- 7.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].
- 13.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].
- 17.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.Google Scholar
- 20.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.Google Scholar
- 21.Anatomical Therapeutic Chemical Classification System [online]. Available from URL: http://www.who.int/classifications/atcddd/en/ [Accessed 2012 6th June].
- 22.Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: McGraw-Hill; 1998.Google Scholar
- 43.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.Google Scholar