title: Comprehensive medication reviews for elderly patients: findings and recommendations to physicians.
abstract: OBJECTIVE
  To assess drug-related problems (DRPs) documented by specially trained community pharmacists during the Finnish comprehensive medication review (CMR) procedure and to describe the resulting interventions for home-dwelling and assisted-living primary care patients 65 years or older.
  
  
  METHODS
  Retrospective analysis of applicable written CMR case reports for primary care patients 65 years or older by 26 community pharmacists attending a 1.5-year CMR accreditation training (174 patients recruited; 121 included in the analysis). The main outcome measures were DRPs and physicians' acceptance of pharmacists' recommendations.
  
  
  RESULTS
  The pharmacists reported a total of 785 DRPs (average of 6.5/patient). DRPs were more common among home-dwelling patients (7.2) than those in the assisted-living setting (5.5; P = 0.014) but were similar in nature. Inappropriate drug choices were the most common DRPs (17% of DRPs), involving most often hypnotics and sedatives. Also, indications with no treatment were common (16%), particularly those associated with cardiovascular diseases and osteoporosis. Pharmacists made 649 recommendations, 55% (n = 360) of which were accepted by physicians without revision. In 51% of DRPs (n = 403), CMRs resulted in change of drug therapy; stopping a drug was the most common change.
  
  
  CONCLUSIONS
  Specially trained pharmacists were able to identify DRPs among elderly primary care patients by using a CMR procedure, and more than one-half of the identified DRPs led to medication changes. The pharmacists' special knowledge of geriatric pharmacotherapy and access to clinical patient data were crucial for recognizing DRPs.
authors.affiliation: Faculty of Pharmacy, University of Helsinki, Helsinki, Finland. saija.leikola@gmail.com
authors.forename: Saija N S
authors.initials: SN
authors.lastname: Leikola
authors.forename: Johanna
authors.initials: J
authors.lastname: Virolainen
authors.forename: Lea
authors.initials: L
authors.lastname: Tuomainen
authors.forename: Raimo K
authors.initials: RK
authors.lastname: Tuominen
authors.forename: Marja S A
authors.initials: MS
authors.lastname: Airaksinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010347:Patient Care Planning / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies