Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial.
OBJECTIVE
to measure the impact of pharmacist-conducted clinical medication review with elderly care home residents.


METHODS
randomised controlled trial of clinical medication review by a pharmacist against usual care.


METHODS
sixty-five care homes for the elderly in Leeds, UK.


METHODS
a total of 661 residents aged 65+ years on one or more medicines.


METHODS
clinical medication review by a pharmacist with patient and clinical records. Recommendations to general practitioner for approval and implementation. Control patients received usual general practitioner care.


METHODS
primary: number of changes in medication per participant. Secondary: number and cost of repeat medicines per participant; medication review rate; mortality, falls, hospital admissions, general practitioner consultations, Barthel index, Standardised Mini-Mental State Examination (SMMSE).


RESULTS
the pharmacist reviewed 315/331 (95.2%) patients in 6 months. A total of 62/330 (18.8%) control patients were reviewed by their general practitioner. The mean number of drug changes per patient were 3.1 for intervention and 2.4 for control group (P < 0.0001). There were respectively 0.8 and 1.3 falls per patient (P < 0.0001). There was no significant difference for GP consultations per patient (means 2.9 and 2.8 in 6 months, P = 0.5), hospitalisations (means 0.2 and 0.3, P = 0.11), deaths (51/331 and 48/330, P = 0.81), Barthel score (9.8 and 9.3, P = 0.06), SMMSE score (13.9 and 13.8, P = 0.62), number and cost of drugs per patient (6.7 and 6.9, P = 0.5) (pounds sterling 42.24 and pounds sterling 42.94 per 28 days). A total of 75.6% (565/747) of pharmacist recommendations were accepted by the general practitioner; and 76.6% (433/565) of accepted recommendations were implemented.


CONCLUSIONS
general practitioners do not review most care home patients' medication. A clinical pharmacist can review them and make recommendations that are usually accepted. This leads to substantial change in patients' medication regimens without change in drug costs. There is a reduction in the number of falls. There is no significant change in consultations, hospitalisation, mortality, SMMSE or Barthel scores.
Zermansky
Arnold Geoffrey
AG
Pharmacy Practice and Medicines Management Group, School of Healthcare, Baines Wing, University of Leeds, PO Box 214, Leeds LS2 9UT, UK. a.g.zermansky@leeds.ac.uk
Alldred
David Phillip
DP
Petty
Duncan Robert
DR
Raynor
David K
DK
Freemantle
Nick
N
Eastaugh
Joanne
J
Bowie
Peter
P
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists