title: Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes.
abstract: BACKGROUND
  Despite many research studies demonstrating the benefit in clinical, economic, and humanistic outcomes of professional pharmacy services, there is a paucity of evidence when these services become incorporated into the usual practice of a community pharmacy.
  
  
  OBJECTIVE
  The objective of the present study was to evaluate the clinical, economic, and humanistic impact of a pharmacist-conducted medication review with follow-up following 18 months implementation.
  
  
  METHODS
  Community pharmacies in Spain.
  
  
  METHODS
  The study used an effectiveness-implementation hybrid design. During the follow-up, patients attended the pharmacy on a monthly basis and received the medication review with follow-up service.
  
  
  METHODS
  Economic, clinical, and humanistic measures were used to assess the impact of the service.
  
  
  RESULTS
  132 patients received the service. During the 18 months of follow-up, 408 negative outcomes related to medicines (which are uncontrolled health problems) were identified, of which 393 were resolved. The average number of medicines used by patients significantly decreased from 6.1 (SD: 2.9) to 3.3 (SD: 2.2). A significant decrease was also observed in hospitalizations [OR = 0.31 (IC 95% = 0.10-0.99)] and in emergency department visits [OR = 0.16 (IC 95% = 0.05-0.55); p = 0.001]. A general trend to increase all quality of life domains was observed over time. The higher increase was observed in the construct health transition [mean increase: 30.7 (SD: 25.4)], followed by bodily pain [mean increase: 22.3 (SD: 25.4)], and general health [mean increase: 20.7 (SD: 23.7)]. Medication knowledge significantly increased in terms of aggregated domains of dose, frequency, drug indication [from 8.9 (SD: 17.5) to 87.9 (SD: 25.0)], and dose and frequency [from 9.3 (SD: 17.9) to 92.5 (22.1)]. Although a slight improvement was observed in terms of drug indication, this increase was not statistically significant. 68 out of 132 patients (51.5%) were non-adherent to their treatment. This number decreased to 1 (0.8%) after the follow-up [OR = 0.007 (IC 95%: 0.001-0.053) p < 0.001].
  
  
  CONCLUSIONS
  A community pharmacy based medication review with follow-up service delivered by a trained pharmacist, has positive effects across clinical, economic, and humanistic outcomes. These results are consistent with previous studies. Incorporating community pharmacists into the multidisciplinary team is a reliable solution to improve health care.
authors.affiliation: Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain.
authors.forename: Carla Castrillon
authors.initials: CC
authors.lastname: Ocampo
authors.affiliation: Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain. Victoria.garciacardenas@uts.edu.au.|Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia. Victoria.garciacardenas@uts.edu.au.
authors.forename: Victoria
authors.initials: V
authors.lastname: Garcia-Cardenas
authors.affiliation: Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martinez-Martinez
authors.affiliation: Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
authors.forename: Shalom I
authors.initials: SI
authors.lastname: Benrimoj
authors.affiliation: Grupo Promoción y Prevención Farmacéutica, Departamento de Farmacia, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia.
authors.forename: Pedro
authors.initials: P
authors.lastname: Amariles
authors.affiliation: Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gastelurrutia
mesh_terms: D000368:Aged; D003157:Community Pharmacy Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019338:Polypharmacy; D013030:Spain
keywords: Community pharmacy; Drug-related problems; Implementation research; Medication review; Negative outcomes; Pharmaceutical care; Professional pharmacy services; Spain