title: Medication reviews in primary care in Sweden: importance of clinical pharmacists' recommendations on drug-related problems.
abstract: BACKGROUND
  One way of preventing and solving drug-related problems in frail elderly is to perform team-based medication reviews.
  
  
  OBJECTIVE
  To evaluate the quality of the clinical pharmacy service to primary care using structured medication reviews, focusing on the clinical significance of the recommendations made by clinical pharmacists.
  
  
  METHODS
  A random sample of 150 patients (out of 1541) who received structured team based medication reviews. The patients lived at a geriatric nursing home or were ≥65 years and lived in ordinary housing with medication-related community help.
  
  
  METHODS
  Based on information on symptoms, kidney function, blood pressure, diagnoses and the medication list, a pharmacist identified possible drug-related problems and supplied recommendations for the general practitioner to act on. Two independent physicians retrospectively ranked the clinical significance of the recommendations according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Main outcome measure The clinical significance of the recommendations. Results In total 349 drug-related problems were identified, leading to recommendations. The vast majority of the recommendations (96 %) were judged to have significance 3 or higher and more than the half were judged to have significance 4 or higher.
  
  
  CONCLUSIONS
  The high proportion of clinically significant recommendations provided by pharmacists when performing team-based medication reviews suggest that these clinical pharmacy services have potential to increase prescribing quality. As such, the medication reviews have the potential for contributing to a better and safer drug therapy for elderly patients.
authors.affiliation: Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden. sara.modig@med.lu.se.|Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Malmö, Sweden. sara.modig@med.lu.se.
authors.forename: Sara
authors.initials: S
authors.lastname: Modig
authors.affiliation: Department of Medicine, Lund University Hospital, Lund, Sweden.
authors.forename: Lydia
authors.initials: L
authors.lastname: Holmdahl
authors.affiliation: Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden.|Department of Laboratory Medicine/Clinical Pharmacology, Lund University, Lund, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Bondesson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003157:Community Pharmacy Services / Q000592:standards; D004339:Drug Compounding; D054796:Drug Dosage Calculations; D011307:Drug Prescriptions; D057915:Drug Substitution; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D016330:Frail Elderly; D006707:Homes for the Aged; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D057187:Independent Living; D008297:Male; D055118:Medication Adherence; D059065:Medication Reconciliation; D054539:Medication Therapy Management / Q000592:standards; D009735:Nursing Homes; D010348:Patient Care Team; D061214:Patient Safety; D010595:Pharmacists / Q000592:standards; D011320:Primary Health Care / Q000592:standards; D024382:Professional Role; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden
keywords: Clinical significance; DRP; Drug-related problem; Medication review; Primary care; Sweden