The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: results of a cohort study.
BACKGROUND
Randomized controlled trials have demonstrated that collaborative medication reviews can improve outcomes for patients with heart failure. We aimed to determine whether these results translated into Australian practice, where collaborative reviews are nationally funded.


RESULTS
This retrospective cohort study using administrative claims data included veterans 65 years and older receiving bisoprolol, carvedilol, or metoprolol succinate for which prescribing physicians indicated treatment was for heart failure. We compared those exposed to a general practitioner-pharmacist collaborative home medication review with those who did not receive the service. The service includes physician referral, a home visit by an accredited pharmacist to identify medication-related problems, and a pharmacist report with follow-up undertaken by the physician. Kaplan-Meier analyses and Cox proportional hazards models were used to compare time until next hospitalization for heart failure between the exposed and unexposed groups. There were 273 veterans exposed to a home medicines review and 5444 unexposed patients. Average age in both groups was 81.6 years (no significant difference). The median number of comorbidities was 8 in the exposed group and 7 in the unexposed (P<0.0001). Unadjusted results showed a 37% reduction in rate of hospitalization for heart failure at any time (hazard ratio, 0.63; 95% CI, 0.44 to 0.89). Adjusted results showed a 45% reduction (hazard ratio, 0.55; 95% CI, 0.39 to 0.77) among those who had received a home medicines review compared with the unexposed patients.


CONCLUSIONS
Medicines review in the practice setting is effective in delaying time to next hospitalization for heart failure in those treated with heart failure medicines.
Roughead
Elizabeth E
EE
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, North Terrace, GPO Box 2471, Adelaide, South Australia 5001. libby.roughead@unisa.edu.au
Barratt
John D
JD
Ramsay
Emmae
E
Pratt
Nicole
N
Ryan
Philip
P
Peck
Robert
R
Killer
Graeme
G
Gilbert
Andrew L
AL
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017298:Bisoprolol / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D019992:Databases as Topic; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008790:Metoprolol / Q000031:analogs & derivatives / Q000627:therapeutic use; D015397:Program Evaluation; D011412:Propanolamines / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data; D017805:Widowhood / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol; D017298:Bisoprolol