Clinical medication review by a pharmacist of elderly patients on repeat medications in general practice — pharmacist interventions and review outcomes

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Abstract
Objectives To describe the nature and rate of interventions made by a pharmacist conducting clinical medication reviews in general practice. Method Patients, randomly allocated to the intervention group, in a randomised controlled trial of 1,188 patients, were invited to a pharmacist-conducted medication review clinic at their general practice. Patients were seen over one year from June 1, 1999, to May 31, 2000. In the consultation an assessment was made of the patient, their clinical conditions and medication. Consultation outcomes for each patient and intervention outcomes for each medicine were evaluated. Setting Patients were recruited from four randomly selected general practices in Leeds, UK. Patients were eligible if aged 65 years or over and on at least one repeat medicine. Key findings Consultations were held with 590 patients in the intervention group (97 per cent). A recommendation for change was made in 44 per cent (258/591) of consultations. The most common outcome was a change in medication: 29 per cent of consultations (170/591). Doctor referral occurred for 28 patients (5 per cent) and nurse referral for 25 (4 per cent). Study patients were recorded as taking 2,927 repeat medications (mode of two per patient). Interventions were made for 21 per cent of medications (603). Clinically related interventions accounted for 71 per cent (430/603). Recommendations were spread evenly across therapy groups. At the study end, 90 per cent (433/484) of recommendations remained implemented. Conclusion A pharmacist who clinically reviewed elderly patients, their conditions and their medications, intervened in nearly half the patients. The pharmacist was able to implement most interventions without referring the patient to a doctor or nurse.