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Improving the Well-Being of Elderly Patients via Community Pharmacy-Based Provision of Pharmaceutical Care

A Multicentre Study in Seven European Countries

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Abstract

Objective

This study aimed to measure the outcomes of a harmonised, structured pharmaceutical care programme provided to elderly patients (≥65 years of age) by community pharmacists in a multicentre international study performed in 7 European countries.

Design and setting

The study was a randomised, controlled, longitudinal, clinical trial with repeated measures performed over an 18-month period. A total of 104 intervention and 86 control pharmacy sites participated in the research and 1290 intervention patients and 1164 control patients were recruited into the study.

Main outcome measures and results

A general decline in health-related quality of life over time was observed in the pooled data; however, significant improvements were achieved in patients involved in the pharmaceutical care programme in some countries. Intervention patients reported better control of their medical conditions as a result of the study and cost savings associated with pharmaceutical care provision were observed in most countries. The new structured service was well accepted by intervention patients and patient satisfaction with the services improved during the study. The pharmacists involved in providing pharmaceutical care had a positive opinion on the new approach, as did the majority of general practitioners surveyed. The positive effects appear to have been achieved via social and psychosocial aspects of the intervention, such as the increased support provided by community pharmacists, rather than via biomedical mechanisms.

Conclusions

This study is the first large-scale, multicentre study to investigate the effects of pharmaceutical care provision by community pharmacists to elderly patients. Future research methodology and implementation will be informed by the experience gained from this challenging trial.

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References

  1. Anon. World-wide developments in pharmaceutical care. Proceedings from the Joint International Symposium on Pharmaceutical Care. Pharm J 1998; 260: 563–8

  2. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990; 47: 533–42

    PubMed  CAS  Google Scholar 

  3. Kozma CM, Reeder CE, Schulz RM. Economic, clinical and humanistic outcomes: a planning model for pharmacoeconomic research. Clin Ther 1993; 15: 1121–32

    PubMed  CAS  Google Scholar 

  4. Holford DA, Smith S. Improving the quality of outcomes research involving pharmaceutical services. Am J Health Syst Pharm 1997; 54: 1434–42

    Google Scholar 

  5. Maguire TA. Pharmaceutical care — who pays? Pharm J 1995; 254: 642

    Google Scholar 

  6. Kennie NR, Schuster BG, Einarson TR. Critical analysis of the pharmaceutical care research literature. Ann Pharmacother 1998; 32: 17–26

    Article  PubMed  CAS  Google Scholar 

  7. Carter BL, Helling DK. Ambulatory care pharmacy services: has the agenda changed. Ann Pharmacother 2000; 34: 772–87

    Article  PubMed  CAS  Google Scholar 

  8. Grainger-Rousseau TJ, McElnay JC. A model for community pharmacy involvement with general practitioners in the management of asthmatic patients. J App Ther 1996; 1: 145–61

    Google Scholar 

  9. Herborg H, Søndergaard B, Frokjaer B, et al. Pharmaceutical care value proved. Int Pharm J 1996; 10: 167–8

    Google Scholar 

  10. Van Veldhuisen-Scott MK, Widmer LB, Stacey SA, et al. Developing and implementing a pharmaceutical care model in a ambulatory care setting for patients with diabetes. Diabetes Educ 1995; 21: 117–24

    Article  Google Scholar 

  11. Park JJ, Kelly P, Carter BL, et al. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc 1996; 36: 443–51

    Google Scholar 

  12. 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

    PubMed  CAS  Google Scholar 

  13. Hanlon JT, Weinberger M, Samsa GP, 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

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. Grymonpre RE, Williamson DA, Huynh DH, et al. A community-based pharmaceutical care model for the elderly: report on a pilot study. Int J Pharm Pract 1994; 2: 229–34

    Article  Google Scholar 

  16. Burgess J, White GN. A PC project with the elderly. Pharmacy Practice 1996; 12: 61–9

    Google Scholar 

  17. March G, Gilbert A, Roughead E, et al. Developing and evaluating a model for pharmaceutical care in Australian community pharmacies. Int J Pharm Pract 1999; 7: 220–9

    Article  Google Scholar 

  18. Kimberlin CL, Berardo DH, Pendergast JF, et al. Effects of an education programme for community pharmacists on detecting drug-related problems in the elderly. Med Care 1993; 31: 451–68

    Article  PubMed  CAS  Google Scholar 

  19. Stewart RB. Polypharmacy in the elderly: a fait accompli? Ann Pharmacother 1990; 24: 321–3

    CAS  Google Scholar 

  20. Weedle P, Parish P. Pharmaceutical care of the elderly: 1. The extent of drug use in the elderly. Br J Pharm Pract 1984; 6: 352–8

    Google Scholar 

  21. Hale WE, Perkins LL, May FE, et al. Symptom prevalence in the elderly: an evaluation of age, sex, disease and medication usage. J Am Geriatr Soc 1986; 34: 333–40

    PubMed  CAS  Google Scholar 

  22. Wade WE, Cobb HH, Cooper JW. Drug-related problems in a multiple site ambulatory geriatric population. J Ger Drug Ther 1986; 1: 67–79

    Google Scholar 

  23. Berardo DH, Kimberlin CL, McKenzie LC, et al. Community pharmacists’ documentation of interventions on drug-related problems of elderly patients. J Soc Admin Pharm 1994; 11: 182–93

    Google Scholar 

  24. Schmader K, Hanlon JT, Weinberger M, et al. Appropriateness of medication prescribing in ambulatory elderly patients. J Am Geriatr Soc. 1994; 42: 1092–8

    Google Scholar 

  25. Schmader K, Hanlon JT, Landsman PB, et al. Inappropriate prescribing and health outcomes in elderly veteran outpatients. Ann Pharmacother 1997; 31: 529–32

    PubMed  CAS  Google Scholar 

  26. Stuck AE, Beers MH, Steiner A, et al. Inappropriate medication use in community-residing older persons. Arch Intern Med 1994; 154: 2195–200

    Article  PubMed  CAS  Google Scholar 

  27. Wilcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA 1994; 272: 292–6

    Article  Google Scholar 

  28. Shimp LA, Asicone FJ, Howard MG, et al. Potential medication-related problems in noninstitutionalised elderly. Drug Intell Clin Pharm 1985; 19: 766–72

    PubMed  CAS  Google Scholar 

  29. Murray MD, Darnell J, Weinberger M, et al. Factors contributing to medication noncompliance in elderly public housing tenants. Drug Intell Clin Pharm 1986; 20: 146–52

    PubMed  CAS  Google Scholar 

  30. Beyth RJ, Shorr RI. Epidemiology of adverse drug reactions in the elderly by drug class. Drugs Aging 1999; 14: 231–9

    Article  PubMed  CAS  Google Scholar 

  31. Veehof LJG, Stewart RE, Meyboom-de Jong B, et al. Adverse drug reactions and polypharmacy in the elderly in general practice. Eur J Clin Pharmacol 1999; 55: 533–6

    Article  PubMed  CAS  Google Scholar 

  32. Cunningham G, Dodd TRP, Grant DJ, et al. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age Ageing 1997; 26: 375–82

    Article  PubMed  CAS  Google Scholar 

  33. Mannesse CK, Derkx FH, de Riddler MAJ, et al. Adverse drug reactions in elderly patients as contributing factor for hospital admission: cross sectional study. BMJ 1997; 315: 1057–8

    Article  PubMed  CAS  Google Scholar 

  34. Roughead EE, Gilbert AL, Primrose JG, et al. Drug-related hospital admissions: a review of Australian studies published 1988–1996. Med J Aust 1998; 168: 405–8

    PubMed  CAS  Google Scholar 

  35. Asicone FJ, Shimp LA, Opdycke RAL. Research in pharmaceutical care: experience from the focused drug therapy review program. Am J Pharm Educ 1992; 56: 441–7

    Google Scholar 

  36. Ware JE, Snow KK, Kosinski M, et al. SF-36 Health Survey: manual and interpretation guide. Boston (MA): The Health Institute, New England Medical Centre, 1993

    Google Scholar 

  37. Aaronson NK, Acquadro C, Alonso J, et al. International quality of life assessment (IQOLA) project. Qual Life Res 1992; 1: 349–51

    Article  PubMed  CAS  Google Scholar 

  38. Drummond MF. Comparing cost-effectiveness across countries: the model of acid-related disease. Pharmacoeconomics 1994; 5Suppl. 3: 60–7

    Article  Google Scholar 

  39. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24: 67–74

    Article  PubMed  CAS  Google Scholar 

  40. Pickard AS, Johnson JS, Farris KB. The impact of pharmacist interventions on health-related quality of life. Ann Pharmacother 1999; 33: 1167–72

    Article  PubMed  CAS  Google Scholar 

  41. Brazier JE, Harper R, Jones NMB, et al. Validating the SF-36 Health Survey Questionnaire: new outcome for primary care. BMJ 1992; 305: 160–4

    Article  PubMed  CAS  Google Scholar 

  42. McHorney CA. Measuring and monitoring general health status in elderly persons: practical and methodological issues in using the SF-36 health survey. Gerontologist 1996; 36: 571–83

    Article  PubMed  CAS  Google Scholar 

  43. Johnson JA, Bootman JL. Drug-related morbidity and mortality: a cost-of-illness model. Arch Intern Med 1995; 155: 1949–56

    Article  PubMed  CAS  Google Scholar 

  44. MacKeigan LD, Larson LN. Development and validation of an instrument to measure patient satisfaction with pharmacy services. Med Care 1989; 27: 522–36

    Article  PubMed  CAS  Google Scholar 

  45. Larson LN, MacKeigan LD. Further validation of an instrument to measure patient satisfaction with pharmacy services. J Pharm Mark Manage 1994; 8: 125–39

    Google Scholar 

  46. Schommer JC. Kucukarslan SN. Measuring patient satisfaction with pharmaceutical services. Am J Health Syst Pharm 1997; 54: 2721–32

    PubMed  CAS  Google Scholar 

  47. Ried LD, Wang F, Young H, et al. Patients’ satisfaction and their perception of the pharmacist. J Am Pharm Assoc 1999; 39: 835–42

    CAS  Google Scholar 

  48. Borgsdorf LR, Miano R, Knapp KK. Pharmacist managed medication review in a managed care system. Am J Hosp Pharm 1994; 51: 772–7

    PubMed  CAS  Google Scholar 

  49. Søndergaard B, Thorleifsson S, Herborg H, et al. Quality improvement of drug therapy for asthma patients — health economic analysis. Ugeskr Laeger 2000; 162: 480–6

    PubMed  Google Scholar 

  50. Norwood GJ, Sleath BL, Caiola SM, et al. Costs of implementing pharmaceutical care in community pharmacies. J Am Pharm Assoc 1998; 38: 755–61

    CAS  Google Scholar 

  51. Ascione FJ, Shimp LA. The effectiveness of four educational strategies in the elderly. Drug Intell Clin Pharm 1984; 18: 926–31

    PubMed  CAS  Google Scholar 

  52. Varma S, McElnay JC, Hughes CM, et al. Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. Pharmacotherapy 1999; 19: 860–9

    Article  PubMed  CAS  Google Scholar 

  53. Lipton HL, Bird JA. The impact of clinical pharmacist’ consultations on geriatric patients’ compliance and medical care use: a randomised controlled trial. Gerontologist 1994; 34: 307–15

    Article  PubMed  CAS  Google Scholar 

  54. Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity and applications. J Clin Epidemiol 1997; 50: 105–16

    Article  PubMed  CAS  Google Scholar 

  55. Maller W. Continuous quality improvement of drug use in a local area — an interdisciplinary pilot project in the primary health care sector in Vejen county [thesis]. Copenhagen: University of Copenhagen, 1998

    Google Scholar 

  56. Singhal PK, Raisch DW, Gupchup GV. The impact of pharmaceutical services in community and ambulatory care settings: evidence and recommendations for future research. Ann Pharmacother 1999; 33: 1336–55

    Article  PubMed  CAS  Google Scholar 

  57. McNeely EA, Clements SD. Recruitment and retention of the older adult into research studies. J Neurosci Nurs 1994; 26: 57–61

    Article  PubMed  CAS  Google Scholar 

  58. Nau DP, Ried LD, Lipowski EE, et al. Patients’ perceptions of the benefits of pharmaceutical care. J Am Pharm Assoc 2000; 40: 36–40

    CAS  Google Scholar 

  59. van Mil JWF, editor. International working conference on outcomes measurement in pharmaceutical care. Proceedings of the First International Conference of the Pharmaceutical Care Network in Europe; 1999 Jan 26–29; Pharmakon: Hillerod, Denmark, 1999

    Google Scholar 

  60. van Mil JWF, Tromp TFJ. The Pharmaceutical Care Network in Europe (PCNE). Int Pharm J 1997; 11: 10–11

    Google Scholar 

  61. Odedina FT, Segal R, Hepler CD. Providing pharmaceutical care in community practice: differences between providers and non-providers of pharmaceutical care. J Soc Admin Pharm 1995; 12: 170–80

    Google Scholar 

  62. Bell HB, McElnay JC, Hughes CM, et al. A qualitative investigation of the attitudes and opinions of community pharmacists to pharmaceutical care. J Admin Soc Pharm 1998; 15: 284–95

    Google Scholar 

  63. 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 

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Acknowledgements

We acknowledge the European Commission, under the BIOMED 2 programme for medical research, for funding the coordination of the multicentre study. The following groups are also thanked for their financial and/or logistical support in the respective countries: Northern Pharmacies Trust (Northern Ireland); Apotekerfonden of 1991, The Association of Danish Pharmacists Development Fund, Danish Pharmacy Assistants Association (Denmark); Administração Regional de Saúde do Centro, Departmento de Estudos e Planeamento da Saúde — Direccção Geral da Saúde and Instituto Nacional da Farmácia e do Medicamento, Departments of the Health Ministry (Portugal); KNMP — The Royal Dutch Association for the Advancement of Pharmacy, OPG, Brocacef and Interpharm (wholesale companies) and the Stichting Pharmaceutical Care (Pharmaceutical Care Foundation) [The Netherlands]; The Pharmacoepidemiology Fund (Republic of Ireland); Apotekerkammer Westfalen-Lippe, Arz Haan and ABDATA Eschborn (Germany); and Apoteket AB (National Pharmacy Company) and the National Board of Health and Welfare (Sweden).

Thanks are also due to all community pharmacists, other primary healthcare staff and the patients who participated in the research project in their respective countries. We would like to acknowledge the statistical support of Dr Gordon Cran and Dr Derrick Bennett.

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Bernsten, C., Björkman, I., Caramona, M. et al. Improving the Well-Being of Elderly Patients via Community Pharmacy-Based Provision of Pharmaceutical Care. Drugs & Aging 18, 63–77 (2001). https://doi.org/10.2165/00002512-200118010-00005

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