title: Treatment reviews of older people on polypharmacy in primary care: cluster controlled trial comparing two approaches.
abstract: BACKGROUND
  Older people are prone to problems related to use of medicines. As they tend to use many different medicines, monitoring pharmacotherapy for older people in primary care is important.
  
  
  OBJECTIVE
  To determine which procedure for treatment reviews (case conferences versus written feedback) results in more medication changes, measured at different moments in time. To determine the costs and savings related to such an intervention.
  
  
  METHODS
  Randomised, controlled trial, randomisation at the level of the community pharmacy.
  
  
  METHODS
  Primary care; treatment reviews were performed by 28 pharmacists and 77 GPs concerning 738 older people (> or =75 years) on polypharmacy (>five medicines).
  
  
  METHODS
  In one group, pharmacists and GPs performed case conferences on prescription-related problems; in the other group, pharmacists provided results of a treatment review to GPs as written feedback. Number of medication changes was counted following clinically-relevant recommendations. Costs and savings associated with the intervention at various times were calculated.
  
  
  RESULTS
  In the case-conference group significantly more medication changes were initiated (42 versus 22, P = 0.02). This difference was also present 6 months after treatment reviews (36 versus 19, P = 0.02). Nine months after treatment reviews, the difference was no longer significant (33 versus 19, P = 0.07). Additional costs in the case-conference group seem to be covered by the slightly greater savings in this group.
  
  
  CONCLUSIONS
  Performing treatment reviews with case conferences leads to greater uptake of clinically-relevant recommendations. Extra costs seem to be covered by related savings. The effect of the intervention declines over time, so performing treatment reviews for older people should be integrated in the routine collaboration between GPs and pharmacists.
authors.affiliation: Centre for Quality of Care Research, UMC St Radboud, Nijmegen, the Netherlands. W.Denneboom@kwazo.umcn.nl
authors.forename: Wilma
authors.initials: W
authors.lastname: Denneboom
authors.forename: Maaike G H
authors.initials: MG
authors.lastname: Dautzenberg
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
mesh_terms: D000368:Aged; D003157:Community Pharmacy Services / Q000191:economics; D005194:Family Practice / Q000191:economics; D005260:Female; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D005791:Patient Care / Q000191:economics / Q000379:methods* / Q000592:standards; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration / Q000592:standards; D019338:Polypharmacy; D016896:Treatment Outcome