A community-based pharmaceutical care model for the elderly: report on a pilot project

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Abstract
This paper describes the development and pilot evaluation of a pharmacy consultation service for the elderly. The service is a comprehensive, community-based pharmaceutical care model which identifies drug-related problems in the elderly population. Eligible clients were 55+ years of age, taking two or more items of medication and non-institutionalised. The pharmaceutical care model involved home medication histories, drug therapy review, and consultation with physicians and individual clients. The service was evaluated through therapeutic outcomes monitoring, follow-up interviews with clients and questionnaires mailed to physicians. The 20 pilot clients had a mean age of 77 ± 7 years. They took a mean of 8.6 ±3.7 prescription drugs and 9.2 ± 7.9 non-prescription drugs. Potential and actual problems identified which could have adversely affected desired therapeutic outcomes included adverse drug reactions, untreated indications, suboptimal regimens, and improper drug selection. Sixteen of the 20 pilot clients participated in follow-up interviews. A reduction in the number of non-current labels was the only statistically significant difference noted between baseline and follow-up interviews. However, changes consistent with pharmacy recommendations were noted for almost all other drug-related problems identified. Questionnaires relating to 16 clients were completed by 15 physicians. Although the physicians agreed with 79 per cent of the recommendations, only 31 per cent of recommendations resulted in a change to the drug regimen. The majority of physicians surveyed rated the service as somewhat useful to very useful. The need for pharmaceutical review in this population is demonstrated by the number of drug-related problems identified. Although the model led to numerous positive outcomes, further research is required to evaluate the effectiveness of this proposed strategy.
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