Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.
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.
Pope
George
G
Mid Western Regional Hospital, Clinical Age Assessment Unit, Limerick, Ireland. georgepopea@gmail.com
Wall
Noreen
N
Peters
Catherine Mary
CM
O'Connor
Margaret
M
Saunders
Jean
J
O'Sullivan
Catherine
C
Donnelly
Teresa M
TM
Walsh
Thomas
T
Jackson
Steven
S
Lyons
Declan
D
Clinch
David
D
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