title: A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients.
abstract: 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.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ont.
authors.forename: John
authors.initials: J
authors.lastname: Sellors
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Connie
authors.initials: C
authors.lastname: Sellors
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.forename: Christel
authors.initials: C
authors.lastname: Woodward
authors.forename: Andrew
authors.initials: A
authors.lastname: Willan
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
authors.forename: Roxanne
authors.initials: R
authors.lastname: Cosby
authors.forename: Kristina
authors.initials: K
authors.lastname: Trim
authors.forename: Rolf
authors.initials: R
authors.lastname: Sebaldt
authors.forename: Michelle
authors.initials: M
authors.lastname: Howard
authors.forename: Linda
authors.initials: L
authors.lastname: Hardcastle
authors.forename: Jeff
authors.initials: J
authors.lastname: Poston
mesh_terms: 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*