A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients.
BACKGROUND
Pharmacists can improve patient outcomes in institutional and pharmacy settings, but little is known about their effectiveness as consultants to primary care physicians. We examined whether an intervention by a specially trained pharmacist could reduce the number of daily medication units taken by elderly patients, as well as costs and health care use.


METHODS
We conducted a randomized controlled trial in family practices in 24 sites in Ontario. We randomly allocated 48 randomly selected family physicians (69.6% participation rate) to the intervention or the control arm, along with 889 (69.5% participation rate) of their randomly selected community-dwelling, elderly patients who were taking 5 or more medications daily. In the intervention group, pharmacists conducted face-to-face medication reviews with the patients and then gave written recommendations to the physicians to resolve any drug-related problems. Process outcomes included the number of drug-related problems identified among the senior citizens in the intervention arm and the proportion of recommendations implemented by the physicians.


RESULTS
After 5 months, seniors in the intervention and control groups were taking a mean of 12.4 and 12.2 medication units per day respectively (p = 0.50). There were no statistically significant differences in health care use or costs between groups. A mean of 2.5 drug-related problems per senior was identified in the intervention arm. Physicians implemented or attempted to implement 72.3% (790/1093) of the recommendations.


CONCLUSIONS
The intervention did not have a significant effect on patient outcomes. However, physicians were receptive to the recommendations to resolve drug-related problems, suggesting that collaboration between physicians and pharmacists is feasible.
Sellors
John
J
Department of Family Medicine, McMaster University, Hamilton, Ont.
Kaczorowski
Janusz
J
Sellors
Connie
C
Dolovich
Lisa
L
Woodward
Christel
C
Willan
Andrew
A
Goeree
Ron
R
Cosby
Roxanne
R
Trim
Kristina
K
Sebaldt
Rolf
R
Howard
Michelle
M
Hardcastle
Linda
L
Poston
Jeff
J
D000368:Aged; D001291:Attitude of Health Personnel; D003157:Community Pharmacy Services / Q000458:organization & administration; D003299:Cooperative Behavior; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010348:Patient Care Team; D010595:Pharmacists / Q000458:organization & administration* / Q000523:psychology; D010821:Physicians, Family / Q000458:organization & administration* / Q000523:psychology; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration*