A Pharmacist Consultation Service in Community-Based Family Practices: A Randomized, Controlled Trial in Seniors

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Abstract
Objective: To conduct a pilot study for a larger randomized trial investigating the efficacy and cost-effectiveness of a pharmacist consultation (PC) program for elderly patients in family practice. Design: Randomized, observer-blinded, controlled trial with two patient groups: PC and control. The study pharmacist interviewed each PC program participant in their physician's office, prepared a letter, and reviewed the drug regimen recommendations in the letter with the physician. The number and types of recommendations made, the proportion of the pharmacist's recommendations implemented by physicians, and daily medication use and costs at the end of six months are reported. Setting: One hundred thirty-two patients aged 65 years and older from four family practices in Stoney Creek, Ontario, Canada, who regularly were taking four or more medications. Results: Patient participation rates demonstrated feasibility: 191 patients were eligible, with 132 (69.1%) of these consenting to be enrolled. A mean ± SD of 3.0 ± 1.7 recommendations per patient were made for 62 (93.9%) of 66 patients in the PC group, and 77.8% (119/153) of these recommendations were implemented or partially implemented by the physicians. After six months, the mean numbers of medication units were 14.7 ± 10.8 and 13.9 ± 8.2, p = 0.66. The mean daily medication costs were $2.73 ± 1.78 and $2.47 ± 1.78, p = 0.43 in the control and PC groups, respectively. Conclusions: This pilot study demonstrated the need, the feasibility, and the potential effects of the PC program. The results were used to design a larger trial in which physicians rather than patients were randomized to further evaluate the program.