Impact of a pharmaceutical care model for non-institutionalised elderly: results of a randomised, controlled trial

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Abstract
Objectives To measure the impact of a community-based geriatric pharmaceutical care model on specific process measures. Methods The model was evaluated using a prospective, randomised, controlled study design. Clients who self-presented or were referred by Home Care were eligible if they were 65 years of age or older, non-institutionalised, taking two or more prescribed or non-prescribed medications, and willing to provide signed informed consent. A pharmacist conducted a comprehensive drug therapy review on test clients, then addressed issues with the client and/or the client's physician, with follow-up as required. Measurements included number of drugs, drug knowledge, adherence to therapy, cost of prescribed medicines, and number of reported symptoms obtained from a home medication history conducted by trained volunteers, the provincial prescription claims database, and response to a physician survey. Setting The pharmaceutical care model was situated within a community-based interdisciplinary health clinic targeting non-institutionalised elderly. Key findings One hundred and thirty-five clients were randomised to test (n=69) or control (n=66). A mean of 14.4 (SD 4.6) potential or actual issues were identified in test clients. Ninety-four per cent of physicians agreed with at least one of the pharmacist's recommendations but only 230 of 794 recommendations by the pharmacist (29 per cent) resulted in a change. There was no difference in overall number of prescribed or over-the-counter medications, drug costs, symptoms reported, drug knowledge or medication adherence between test and control groups post-intervention. Future research Further research is needed to identify barriers to changing drug use behaviour and facilitating acceptance of pharmaceutical care in the community.