Age and Ageing Advance Access originally published online on August 12, 2006
Age and Ageing 2006 35(6):586-591; doi:10.1093/ageing/afl075
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Clinical medication review by a pharmacist of elderly people living in care homes—randomised controlled trial
1 Pharmacy Practice and Medicines Management Group, School of Healthcare, Baines Wing, University of Leeds, PO Box 214, Leeds LS2 9UT, UK
2 Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
3 Older People’s Mental Health Department, Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK
Address correspondence to: A. G. Zermansky. Email: a.g.zermansky{at}leeds.ac.uk, zermansky{at}btinternet.com
Objective: to measure the impact of pharmacist-conducted clinical medication review with elderly care home residents.
Design: randomised controlled trial of clinical medication review by a pharmacist against usual care.
Setting: sixty-five care homes for the elderly in Leeds, UK.
Participants: a total of 661 residents aged 65+ years on one or more medicines.
Intervention: clinical medication review by a pharmacist with patient and clinical records. Recommendations to general practitioner for approval and implementation. Control patients received usual general practitioner care.
Main outcome measures: primary: number of changes in medication per participant. Secondary: number and cost of repeat medicines per participant; medication review rate; mortality, falls, hospital admissions, general practitioner consultations, Barthel index, Standardised Mini-Mental State Examination (SMMSE).
Results: the pharmacist reviewed 315/331 (95.2%) patients in 6 months. A total of 62/330 (18.8%) control patients were reviewed by their general practitioner. The mean number of drug changes per patient were 3.1 for intervention and 2.4 for control group (P < 0.0001). There were respectively 0.8 and 1.3 falls per patient (P < 0.0001). There was no significant difference for GP consultations per patient (means 2.9 and 2.8 in 6 months, P = 0.5), hospitalisations (means 0.2 and 0.3, P = 0.11), deaths (51/331 and 48/330, P = 0.81), Barthel score (9.8 and 9.3, P = 0.06), SMMSE score (13.9 and 13.8, P = 0.62), number and cost of drugs per patient (6.7 and 6.9, P = 0.5) (£42.24 and £42.94 per 28 days). A total of 75.6% (565/747) of pharmacist recommendations were accepted by the general practitioner; and 76.6% (433/565) of accepted recommendations were implemented.
Conclusions: general practitioners do not review most care home patients’ medication. A clinical pharmacist can review them and make recommendations that are usually accepted. This leads to substantial change in patients’ medication regimens without change in drug costs. There is a reduction in the number of falls. There is no significant change in consultations, hospitalisation, mortality, SMMSE or Barthel scores.
Keywords: clinical medication review, care home, clinical pharmacist, elderly, falls
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