Authors' objectives:

This report aims:

To determine whether a suitably trained clinical pharmacist could conduct effective clinical medication reviews of elderly patients on repeat medication in general practice, and specifically:

- to assess whether clinical medication review by a pharmacist is a cost-effective method of improving the extent, cost and quality of clinical control of repeat prescribing compared with that achieved by a practices normal procedures

- to evaluate the effect of medication review clinics on the number of practice consultations, outpatient consultations, hospital admissions and deaths

- to identify the types of interventions.

Authors' results and conclusions: The mean numbers of individual medication changes per patient were 2.2 in the intervention group and 1.9 in the control group: difference = 0.31 (95% confidence interval (CI), 0.06 to 0.57); p = 0.02. The numbers of repeat medication items rose in both groups but the rise was significantly less in the intervention group (intervention mean 0.2, standard deviation (SD) 1.55; control mean 0.4, SD 1.53; group difference 0.2, 95% CI, 0.4 to 0.1). Medication costs rose in both groups but the rise was significantly less in the intervention group (intervention mean 1.80 GBP, control mean 6.53 GBP, group difference 4.72 GBP (95% CI, 7.04 to 2.41). The cost saving on medication in the intervention group compared with the control group was 4.75 GBP per 28-day month. Extrapolated for 1 year, this is a saving of 61.75 GBP per patient. There was no evidence of a difference between the groups for the numbers of outpatient consultations, hospital admissions or practice consultations over the 12-month period. There were fewer deaths in the intervention group (15 deaths, 2.5%) than in the control group (25 deaths, 4.3%) but the difference did not reach statistical significance (p = 0.56). Over the 12-month study period, 97% of the intervention group had medication reviews compared with 44% in the control group. A recommendation was made in 258 of the 591 (44%) patient consultations. Only 28 patients (5%) needed referral to a GP and 25 patients (4%) needed referral for a test. The pharmacist dealt with all other medication-related problems. A recommendation was made for 603 of the 2927 repeat medications (21%). The most common recommendations were 'stop the medicine' (118 medicines, 4% of all medicines) and 'technical', for example, a generic switch or removal of a redundant item from repeat list (177, 6%). Of the 603 medication interventions, 395 (65%) were dealt with by the pharmacist alone, without reference to a GP. Recommendations were made to and permission was sought from the GPs for 208 interventions (34%). The pharmacist's advice was accepted and acted upon in 179 instances (86%).

Authors' recommendations: A suitably trained pharmacist can conduct consultations with elderly patients to review them, their medicines and the conditions for which they were prescribed. This intervention resulted in a greater coverage of medication review and more interventions than if the pharmacist was not involved. The pharmacists' interventions led to reductions in the number of drugs taken by the intervention group compared with the control group, and thus to major net financial savings. There was no evidence of an adverse effect on subsequent use of health services. Although the study demonstrates the potential of this extended role for the pharmacist, its reproducibility as a service modality needs to be tested further. Only one, very experienced, pharmacist was involved, working in four selected Leeds practices. It is important to reproduce the results with more pharmacists working in large numbers of practices over a wider geographical and scio-economic area before making fundamental changes to the service and the everyday role of the pharmacist. Nonetheless, it is not unreasonable to predict that clinical medication review will become a core role of the pharmacist and will achieve therapeutic benefits combined with neutral cost implications.

Authors' methods: Randomised controlled trial

Project Status: Completed

URL for project: http://www.hta.ac.uk/1088

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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