title: Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.
abstract: OBJECTIVE
  to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care.
  
  
  METHODS
  prospective, randomised, controlled trial.
  
  
  METHODS
  two residential continuing care hospitals.
  
  
  METHODS
  two hundred and twenty-five permanent patients.
  
  
  METHODS
  patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months.
  
  
  RESULTS
  one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213).
  
  
  CONCLUSIONS
  specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.
authors.affiliation: Mid Western Regional Hospital, Clinical Age Assessment Unit, Limerick, Ireland. georgepopea@gmail.com
authors.forename: George
authors.initials: G
authors.lastname: Pope
authors.forename: Noreen
authors.initials: N
authors.lastname: Wall
authors.forename: Catherine Mary
authors.initials: CM
authors.lastname: Peters
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Connor
authors.forename: Jean
authors.initials: J
authors.lastname: Saunders
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Sullivan
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Donnelly
authors.forename: Thomas
authors.initials: T
authors.lastname: Walsh
authors.forename: Steven
authors.initials: S
authors.lastname: Jackson
authors.forename: Declan
authors.initials: D
authors.lastname: Lyons
authors.forename: David
authors.initials: D
authors.lastname: Clinch
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003266:Continuity of Patient Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D017723:Drug Utilization Review; D015577:Geriatric Assessment; D005853:Geriatrics; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000191:economics*; D011446:Prospective Studies; D012112:Residential Facilities