Pharmacy World and Science

, Volume 25, Issue 5, pp 218–226 | Cite as

Community pharmacy based provision of pharmaceutical care to older patients

  • I.K. Sturgess
  • J.C. McElnay
  • C.M. Hughes
  • G. Crealey
Article

Abstract

Aim: To measure the outcomes of a harmonised, structured pharmaceutical care programme provided to elderly patients by community pharmacists.Method: A randomised, controlled, longitudinal, clinical trial with repeated measures was performed over an 18‐month period, involving community pharmacies (5 intervention and 5 control) in Northern Ireland. Elderly, ambulatory patients (≥ 65 years), taking 4 or more prescribed medications were eligible for participation. Patients attending an intervention pharmacy received education on medical conditions, implementation of compliance strategies, rationalising of drug regimens and appropriate monitoring; patients attending control sites received normal services. A battery of clinical, humanistic and economic outcomes were assessed.Results: A significantly higher proportion of intervention patients were compliant at the end of the 18‐month study and experienced fewer problems with medication compared to control patients (P < 0.05). There was little impact on quality of life and health care utilisation.Conclusions: Pharmaceutical care provision to community‐dwelling patients resulted in an improvement in medication compliance and evidence of cost‐savings. Future pharmaceutical care studies may benefit from a more focussed selective approach to data collection and outcomes measurement.

Community pharmacy Elderly Northern Ireland Pharmaceutical care Randomised controlled trial 

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References

  1. 1.
    Dall JLC. The greying of Europe. BMJ 1994; 309: 1282–5.Google Scholar
  2. 2.
    Yuen P. Compendium of health statistics 1999. 11th ed. London: Office of Health Economics.Google Scholar
  3. 3.
    Weedle P, Parish P. Pharmaceutical care of the elderly. Part 1. The extent of drug use in the elderly. Br J Pharm Pract 1984; 6: 352–8.Google Scholar
  4. 4.
    Hale WE, Perkins LL, May FE, Marks RG, Stewart RB. Symptom prevalence in the elderly: an evaluation of age, sex, disease and medication usage. J Am Geriatr Soc 1986; 34: 333–40Google Scholar
  5. 5.
    Stewart RB. Polypharmacy in the elderly: a fait accompli? Ann Pharmacother 1990; 24: 321-3Google Scholar
  6. 6.
    Royal College of Physicians Medication for older people, 2nd ed. 1997. London: Royal College of Physicians, 1997.Google Scholar
  7. 7.
    Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med 1995; 155: 1949–56.Google Scholar
  8. 8.
    Wade WE, Cobb HH, Cooper JW. Drug-related problems in a multiple site ambulatory geriatric population. J Geriatr Drug Ther 1986; 1: 67–79.Google Scholar
  9. 9.
    Berardo DH, Kimberlin CL, McKenzie LC, Pendergast JF. Community pharmacists' documentation of interventions on drug-related problems of elderly patients. J Soc Admin Pharm 1994; 11: 182–93Google Scholar
  10. 10.
    Westerlund T, Almarsdottris AB, Melander A. Factors influencing the detection rate of drug-related problems in community pharmacy. Pharm World Sci 1999; 21: 245–50.Google Scholar
  11. 11.
    Lindley CM, Tully MO, Paramsothy V, Tallis RC. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing 1992; 21: 294–300.Google Scholar
  12. 12.
    Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK et al. A randomized controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly out-patients with polypharmacy. Am J Med 1996; 100: 428–37.Google Scholar
  13. 13.
    Roughead EE, Gilbert AL, Primrose JG, Sansom LN. Drug-related hospital admissions: A review of Australian studies published 1988–1996. Med J Aust 1998; 168: 405–8.Google Scholar
  14. 14.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990; 47: 533–42.Google Scholar
  15. 15.
    Kennie NR, Schuster BG, Einarson TR. Critical analysis of the pharmaceutical care research literature. Ann Pharmacother 1998; 32: 17–26.Google Scholar
  16. 16.
    Grymonpre RE, Williamson DA, Huynh DH, Desilets LM. A community-based pharmaceutical care model for the elderly: report on a pilot study. Int J Pharm Pract 1994; 2: 229–34Google Scholar
  17. 17.
    Burgess J, White GN. A PC project with the elderly. Pharm Pract 1996; 12: 61–9.Google Scholar
  18. 18.
    Maguire TA. Pharmaceutical care - who pays? Pharm J 1995; 254: 642.Google Scholar
  19. 19.
    Holford DA, Smith S. Improving the quality of outcomes research involving pharmaceutical services. Am J Health System Pharm 1997; 54: 1434–42.Google Scholar
  20. 20.
    Bernsten C, Bjorkman I, Caramona M, Crealey G, Frokjaer B, Grundberger E et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care. Drugs Aging 2001; 18: 63–77.Google Scholar
  21. 21.
    Gore SM. Assessing clinical trials-restricted randomisation. BMJ 1981; 282: 2114–7.Google Scholar
  22. 22.
    March G, Gilbert A, Roughead E, Quintrell N. Developing and evaluating a model for pharmaceutical care in Australian community pharmacies. Int J Pharmacy Pract 1999; 7: 220–9.Google Scholar
  23. 23.
    Strand LM, Morley PC. Drug-related problems. Their structure and function. Drug Intell Clin Pharm 1990; 24: 1093–7.Google Scholar
  24. 24.
    Lobas NH, Lepinski PW, Abramowitz PW. Effects of pharmaceutical care on medication cost and quality of patient care in an ambulatory care clinic. Am J Hosp Pharm 1992; 49: 1681–8.Google Scholar
  25. 25.
    Hammerström B, Wessling A, Nilsson JLG. Pharmaceutical care for patients with skin diseases: a campaign year at Swedish pharmacies. J Clin Pharm Ther 1995; 20: 327–44.Google Scholar
  26. 26.
    Grainger-Rousseau TJ, McElnay JC. A model for community pharmacy involvement with general practitioners in the management of asthmatic patients. J Appl Ther 1996; 1: 145–61.Google Scholar
  27. 27.
    Herborg H, Søndergaard B, Frokjaer B, Fonnesboek L, Gutafsson T, Hepler C. Pharmaceutical care value proved. Int Pharm J 1996; 10: 167–8.Google Scholar
  28. 28.
    Schulz M, Verheyen F, Muhlig S, Muller JM, Muhlbauer K, Knop-Schneickert EK et al. Pharmaceutical care services for asthma patients: a controlled intervention study. J Clin Pharmacol 2001; 41: 668–76.Google Scholar
  29. 29.
    Van Veldhuisen-Scott MK, Widmer LB, Stacey SA, Popovich NG. Developing and implementing a pharmaceutical care model in a ambulatory care setting for patients with diabetes. Diab Educ 1995; 21: 117–24.Google Scholar
  30. 30.
    Park JJ, Kelly P, Carter BL, Burgess PB. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc 1996; 36: 443–51.Google Scholar
  31. 31.
    Erickson SR, Slaughter R, Halapy H. Pharmacists' ability to influence outcomes of hypertension therapy. Pharmacotherapy 1997; 17: 140–7.Google Scholar
  32. 32.
    Bogden PE, Abbott RD, Williamson P, Onopa JK, Koontz LM. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension. J Gen Intern Med 1998; 13: 740–5.Google Scholar
  33. 33.
    Bogden PE, Koontz LM, Williamson P, Abbott RD. The physician and pharmacist team. An effective approach to cholesterol reduction. J Gen Intern Med 1997; 12: 158–64Google Scholar
  34. 34.
    Roland M, Torgerson DJ. Understanding clinical trials: what are pragmatic trials? BMJ 1998; 316: 285.Google Scholar
  35. 35.
    Rogers S, Humphrey C, Nazareth I, Lister S, Tomlin Z, Haines A. Designing trials of interventions to change professional practice in primary care: lessons from an exploratory study of two change strategies. BMJ 2000; 320: 1580–3.Google Scholar
  36. 36.
    Wilson S, Delaney BC, Roalfe A, Roberts L, Redman V, Wearn AM et al. Randomised controlled trials in primary care. BMJ 2000; 321: 24–7.Google Scholar
  37. 37.
    Roland M, Torgerson DJ. Understanding controlled trials. What outcomes should be measured? BMJ 1998; 317: 1075.Google Scholar
  38. 38.
    Hanlon JT, Artz MB. Drug-related problems and pharmaceutical care. What are they, do they matter and what's next? Med Care 2001; 39: 109–12.Google Scholar
  39. 39.
    Cody M, McCombs JS, Parker JP. The Kaiser Permanante/USC patient consultation study: change in quality of life. Am J Health System Pharm 1998; 55: 2615–20.Google Scholar
  40. 40.
    Malone DC, Carter BL, Billups SJ, Valuck RJ, Barnette DJ, Sintek CD et al. Can clinical pharmacists affect SF-36 scores in veterans at high risk for medication-related problems? Med Care 2001; 39: 113–22.Google Scholar
  41. 41.
    Ellerby DA, Williams A, Winfield AJ. The level of interest in pharmacy practice research among community pharmacists. Pharm J 1993; 251: 321–2.Google Scholar
  42. 42.
    McNeely EA, Clements SD. Recruitment and retention of the older adult into research studies. J Neurosci Studies 1994; 26: 57–61.Google Scholar
  43. 43.
    Bell HM, McElnay JC, Hughes CM, Woods A. A qualitative investigation of the attitudes and opinions of community pharmacists to pharmaceutical care. J Soc Admin Pharm 1998; 15: 284–95.Google Scholar
  44. 44.
    Nimmo CM, Holland RW. Transitions in pharmacy practice, part 2: who does what and why. Am J Health System Pharm 1999; 56: 1981–7.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • I.K. Sturgess
    • 1
  • J.C. McElnay
    • 1
  • C.M. Hughes
    • 1
  • G. Crealey
    • 1
  1. 1.Clinical and Practice Research Group, The School of PharmacyQueen's University Belfast, Medical Biology CentreBelfastNorthern Ireland

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