title: Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial.
abstract: 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.
authors.affiliation: 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
authors.forename: Arnold Geoffrey
authors.initials: AG
authors.lastname: Zermansky
authors.forename: David Phillip
authors.initials: DP
authors.lastname: Alldred
authors.forename: Duncan Robert
authors.initials: DR
authors.lastname: Petty
authors.forename: David K
authors.initials: DK
authors.lastname: Raynor
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: Joanne
authors.initials: J
authors.lastname: Eastaugh
authors.forename: Peter
authors.initials: P
authors.lastname: Bowie
mesh_terms: 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