Effects of a pharmacist-led structured medication review in primary care on drug-related problems and hospital admission rates: a randomized controlled trial

Abstract

Objective: To determine whether a pharmacist-led medications review in primary care reduces the number of drugs and the number of drug-related problems.

Design: Prospective randomized controlled trial.

Setting: Liljeholmen Primary Care Centre, Stockholm, Sweden.

Subjects: 209 patients aged ≥ 65 years with five or more different medications. Intervention. Patients answered a questionnaire regarding medications. The pharmacist reviewed all medications (prescription, non-prescription, and herbal) regarding recommendations and renal impairment, giving advice to patients and GPs. Each patient met the pharmacist before seeing their GP. Control patients received their usual care.

Main outcome measures: Drug-related problems and number of drugs. Secondary outcomes included health care utilization and self-rated health during 12 months of follow-up.

Results: No significant difference was seen when comparing change in drug-related problems between the groups. However, a significant decrease in drug-related problems was observed in the intervention group (from 1.73 per patient at baseline to 1.31 at follow-up, p < 0.05). The change in number of drugs was more pronounced in the intervention group (p < 0.046). Intervention group patients were not admitted to hospital on fewer occasions or for fewer days, and there was no significant difference between the two groups regarding utilization of primary care during follow-up. Self-rated health remained unchanged in the intervention group, whereas a drop (p < 0.02) was reported in the control group. This resulted in a significant difference in change in self-rated health between the groups (p < 0.047).

Conclusions: The addition of a skilled pharmacist to the primary care team may contribute to reductions in numbers of drugs and maintenance of self-rated health in elderly patients with polypharmacy.

Keywords: Drug-related problems; Sweden; elderly; general practice; medication review; pharmacist; primary care.

Figure 1.

Overview of study design, patient inclusion, and completion of questionnaires.

Figure 2.

Primary care visits and hospital admissions (number and duration in days) recorded in the control and intervention groups during one year. Data are shown as the median (♦) with 95% CI (▬) and mean (■) values. None of the investigated parameters showed a statistically significant difference. n = 141 patients (75 in the intervention group and 66 in the control group).