Using the costs of drug therapy to screen patients for a community pharmacy-based medication review program.
OBJECTIVE
To measure the positive predictive value (PPV) of the cost of drug therapy (threshold = 2000 Swiss francs [CHF], US$1440, <euro>1360) as a screening criterion for identifying patients who may benefit from medication review (MR). To describe identified drug-related problems (DRPs) and expense problems (EPs), and to estimate potential savings if all recommendations were accepted.


METHODS
Five voluntary Swiss community pharmacies.


METHODS
Of 12,680 patients, 592 (4.7%) had drug therapy costs exceeding 2000 CHF over a six-month period from July 1 to December 31, 2002. This threshold limit was set to identify high-risk patients for DRPs and EPs. Three pharmacists consecutively conducted a medication review based on the pharmaceutical charts of 125 sampled patients who met the inclusion criterion.


METHODS
The PPV of a threshold of 2000 CHF for identifying patients who might benefit from a MR: true positives were patients with at least one DRP, while false positives were patients with no DRP.


RESULTS
The selection based on this criterion had a PPV of 86% for detecting patients with at least one DRP and 95% if EPs were also considered. There was a mean of 2.64 (SD = 2.20) DRPs per patient and a mean of 2.14 (SD = 1.39) EPs per patient. Of these patients, 90% were over 65 years old or were treated with at least five chronic medications, two common criteria for identifying patients at risk of DRPs. The main types of DRPs were drug-drug interactions, compliance problems and duplicate drugs. Mean daily drug cost per patient was CHF 14.87 (US$10.70, <euro>10.10). A potential savings of CHF 1.67 (US$1.20, <euro>1.14) per day (11%) was estimated if all recommendations to solve DRPs and EPs suggested herein were implemented.


CONCLUSIONS
Further studies should investigate whether the potential benefit of medication reviews in preventing DRPs and containing costs in this patient group can be confirmed in a real practice environment.
Ambulatory Care and Community Medicine Department, Community Pharmacy Unit, Pharmaceutical Science Section, University of Geneva, Rue du Bugnon 44, Lausanne 1011, Switzerland.
Jean-Marc
JM
Krähenbühl
Anne
A
Decollogny
Olivier
O
Bugnon
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003157:Community Pharmacy Services / Q000458:organization & administration*; D016527:Drug Costs; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D054539:Medication Therapy Management / Q000191:economics*; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000191:economics; D010595:Pharmacists; D019338:Polypharmacy; D012307:Risk Factors; D013557:Switzerland
D004364:Pharmaceutical Preparations