Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice

Abstract Objective: To determine whether a pharmacist can effectively review repeat prescriptions through consultations with elderly patients in general practice. Design: Randomised controlled trial of clinical medication review by a pharmacist against normal general practice review. Setting: Four g...

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Vydáno v:BMJ Ročník 323; číslo 7325; s. 1340 - 1343
Hlavní autoři: Zermansky, Arnold G, Petty, Duncan R, Raynor, David K, Freemantle, Nick, Vail, Andy, Lowe, Catherine J
Médium: Journal Article
Jazyk:angličtina
Vydáno: England British Medical Journal Publishing Group 08.12.2001
British Medical Association
BMJ Publishing Group Ltd
BMJ Publishing Group LTD
BMJ
Témata:
Aged
Control groups
Cost control
Costs
Dosage
Drug Costs
Drug dosages
Drug evaluation
Drug Prescriptions
Drug use
Drugs
Elderly
Female
Formulae, receipts, prescriptions
General practice
Health care
Health care costs
Humans
Interviews as Topic
Male
Medical formularies
Medications
Medicine
Older adults
Older people
Patient Acceptance of Health Care
Patient care planning
Patient Participation
Patients
Pharmacists
Polypharmacy
Practice Patterns, Physicians
Prescription drugs
Primary Care
Product/Service Evaluations
Workloads
United Kingdom
United Kingdom > UK
ISSN:0959-8138, 1468-5833, 1756-1833
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Shrnutí:Abstract Objective: To determine whether a pharmacist can effectively review repeat prescriptions through consultations with elderly patients in general practice. Design: Randomised controlled trial of clinical medication review by a pharmacist against normal general practice review. Setting: Four general practices. Participants: 1188 patients aged 65 or over who were receiving at least one repeat prescription and living in the community. Intervention: Patients were invited to a consultation at which the pharmacist reviewed their medical conditions and current treatment. Main outcome measures: Number of changes to repeat prescriptions over one year, drug costs, and use of healthcare services. Results: 590 (97%) patients in the intervention group were reviewed compared with 233 (44%) in the control group. Patients seen by the pharmacist were more likely to have changes made to their repeat prescriptions (mean number of changes per patient 2.2 v 1.9; difference=0.31, 95% confidence interval 0.06 to 0.57; P=0.02). Monthly drug costs rose in both groups over the year, but the rise was less in the intervention group (mean difference £4.72 per 28 days, −£7.04 to -£2.41); equivalent to £61 per patient a year. Intervention patients had a smaller rise in the number of drugs prescribed (0.2 v 0.4; mean difference −0.2, −0.4 to −0.1). There was no evidence that review of treatment by the pharmacist affected practice consultation rates, outpatient consultations, hospital admissions, or death rate. Conclusions: A clinical pharmacist can conduct effective consultations with elderly patients in general practice to review their drugs. Such review results in significant changes in patients' drugs and saves more than the cost of the intervention without affecting the workload of general practitioners. What is already known on this topic Review of patients on long term drug treatment is important but is done inadequately Evidence from the United States shows that pharmacists can improve patient care by reviewing drug treatment What this study adds Consultations with a clinical pharmacist are an effective method of reviewing the drug treatment of older patients Review by a pharmacist results in more drug changes and lower prescribing costs than normal care plus a much higher review rate Use of healthcare services by patients is not increased
Bibliografie:ark:/67375/NVC-RBKN3HT1-J
href:bmj-323-1340.pdf
Correspondence to: A G Zermansky
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ArticleID:bmj.323.7325.1340
PMID:11739221
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SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ObjectType-Evidence Based Healthcare-3
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Contributors: AGZ had the original idea for the study and refined it with DKR, CJL, NF, and AV. DRP designed the implementation, ran the drug review clinics, and collected the data. All authors refined the study design, helped interpret the data, and were members of the steering group that oversaw the project. DRP wrote the draft paper, to which all authors then contributed. AV led the statistical analysis and NF the economic analysis. AGZ and DKR are the guarantors.
Correspondence to: A G Zermansky arnoldz@easynet.co.uk
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.323.7325.1340