A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial.
BACKGROUND
Patients 80 years or older are underrepresented in scientific studies. The objective of this study was to investigate the effectiveness of interventions performed by ward-based pharmacists in reducing morbidity and use of hospital care among older patients.


METHODS
A randomized controlled study of patients 80 years or older was conducted at the University Hospital of Uppsala, Uppsala, Sweden. Four hundred patients were recruited consecutively between October 1, 2005, and June 30, 2006, and were randomized to control (n = 201) and intervention (n = 199) groups. The interventions were performed by ward-based pharmacists. The control group received standard care without direct involvement of pharmacists at the ward level. The primary outcome measure was the frequency of hospital visits (emergency department and readmissions [total and drug-related]) during the 12-month follow-up period.


RESULTS
Three hundred sixty-eight patients (182 in the intervention group and 186 in the control group) were analyzed. For the intervention group, there was a 16% reduction in all visits to the hospital (quotient, 1.88 vs 2.24; estimate, 0.84; 95% confidence interval [CI], 0.72-0.99) and a 47% reduction in visits to the emergency department (quotient, 0.35 vs 0.66; estimate, 0.53; 95% CI, 0.37-0.75). Drug-related readmissions were reduced by 80% (quotient, 0.06 vs 0.32; estimate, 0.20; 95% CI, 0.10-0.41). After inclusion of the intervention costs, the total cost per patient in the intervention group was $230 lower than that in the control group.


CONCLUSIONS
If implemented on a population basis, the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs.
Division of Pharmacokinetics and Drug Therapy, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden. Ulrika.gillespie@farmbio.uu.se
Ulrika
U
Gillespie
Anna
A
Alassaad
Dan
D
Henrohn
Hans
H
Garmo
Margareta
M
Hammarlund-Udenaes
Henrik
H
Toss
Asa
A
Kettis-Lindblad
Håkan
H
Melhus
Claes
C
Mörlin
D000367:Age Factors; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009017:Morbidity; D010348:Patient Care Team / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D013548:Sweden; D016896:Treatment Outcome