title: Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients.
abstract: BACKGROUND
  Elderly polypharmacy patients may be more at risk of not adhering to medication. If so, the underlying reasons may be more readily disclosed during private discussions with patients. Hence pharmaceutical care discussions at home might improve treatment adherence.
  
  
  OBJECTIVE
  The aim of this study was to investigate the impact of pharmaceutical care on medication adherence, hospitalisation and mortality in elderly patients prescribed polypharmacy.
  
  
  METHODS
  Pharmaceutical care discussed at home.
  
  
  METHODS
  A randomised controlled trial with two arms; pharmaceutical care (n = 315) and controls (n = 315) was designed. It involved patients aged 65+ years living in Aarhus, Denmark who used five drugs or more without assistance. Pharmacists visited the pharmaceuticalcare patients at home, once only, and followed them during the subsequent year with three telephone calls. Non-adherence was measured by a pill-count. Patients were categorised as non-adherent if their mean adherence rate for all drugs consumed was <80 %. The impact of pharmaceutical care on non-adherence and hospitalisation was analysed by 2 × 2 tables, and mortality by Cox regression.
  
  
  METHODS
  Medication adherence, hospitalisation and mortality.
  
  
  RESULTS
  The final analyses included 517 patients (median age 74 years; females 52 %). Dropouts were more frequent for the pharmaceutical-care group than for controls. Pharmacists encountered drug-related problems amongst 72 % of pharmaceutical-care patients. Pharmaceutical-care patients (11 %) and control patients (10 %) were similarly nonadherent (Odds ratio 1.14; 95 % confidence interval 0.65-2.00), and similar with respect to hospitalisation frequency (30 vs. 28 %; Odds ratio 1.14; 95 % confidence interval 0.78-1.67) and mortality (7.5 vs. 5 %; Hazard ratio 1.41; 95 % confidence interval 0.71-2.82).
  
  
  CONCLUSIONS
  Pharmaceutical care given to our elderly polypharmacy patients made no significant impact on medication adherence, hospitalisation or mortality, when compared to comparable control patients.
authors.affiliation: Department of Geriatrics, Aarhus University Hospital, P.P. Ørumsgade 11, bygn. 7, 1, 8000, Århus C, Denmark, chaolese@rm.dk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Olesen
authors.forename: Philipp
authors.initials: P
authors.lastname: Harbig
authors.forename: Kirsten Marie
authors.initials: KM
authors.lastname: Buus
authors.forename: Ishay
authors.initials: I
authors.lastname: Barat
authors.forename: Else Marie
authors.initials: EM
authors.lastname: Damsgaard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D003718:Denmark / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D009026:Mortality; D010593:Pharmaceutical Services; D019338:Polypharmacy; D012044:Regression Analysis; D016903:Drug Monitoring