title: Factors affecting the delivery of community pharmacist-led medication reviews: evidence from the MedsCheck annual service in Ontario.
abstract: Medication reviews have become part of pharmacy practice across developed countries. This study aimed to identify factors affecting the likelihood of eligible Ontario seniors receiving a pharmacy-led medication review called MedsCheck annual (MCA).
  
  
  
  We designed a cohort study using a random sample of pharmacy claims for MCA-eligible Ontario seniors using linked administrative data from April 2012 to March 2013. Guided by a conceptual framework, we constructed a generalized-estimating-equations model to estimate the effect of patient, pharmacy and community factors on the likelihood of receiving MCA.
  
  
  
  Of the 2,878,958 eligible claim-dates, 65,605 included an MCA. Compared to eligible individuals who did not receive an MCA, recipients were more likely to have a prior MCA (OR = 3.03), receive a new medication on the claim-date (OR = 1.78), be hypertensive (OR = 1.18) or have a recent hospitalization (OR = 1.07). MCA recipients had fewer medications (e.g., OR = 0.44 for ≥12 medications versus 0-4 medications), and were less likely to receive an MCA in a rural (OR = 0.74) or high-volume pharmacy (OR = 0.65).
  
  
  
  The most important determinant of receiving an MCA was having had a prior MCA. Overall, MCA recipients were healthier, younger, urban-dwelling, and taking fewer medications than non-recipients. Policies regarding current and future medication review programs may need to evolve to ensure that those at greatest need receive timely and comprehensive medication reviews.
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada. petros.pechlivanoglou@sickkids.ca.|The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay st, Toronto, M5G0A4, ON, Canada. petros.pechlivanoglou@sickkids.ca.|The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. petros.pechlivanoglou@sickkids.ca.
authors.forename: Petros
authors.identifier: 0000-0001-5090-7936
authors.initials: P
authors.lastname: Pechlivanoglou
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.|The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
authors.forename: Lusine
authors.initials: L
authors.lastname: Abrahamyan
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: MacKeigan
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences , Toronto, ON, Canada.
authors.forename: Giulia P
authors.initials: GP
authors.lastname: Consiglio
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Department of Family Medicine, McMaster Innovation Park University, Hamilton, ON, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.affiliation: Institute for Clinical Evaluative Sciences , Toronto, ON, Canada.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences , Toronto, ON, Canada.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cadarette
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.|The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Valeria E
authors.initials: VE
authors.lastname: Rac
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Jonghyun
authors.initials: J
authors.lastname: Shin
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.|The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|University Health Network, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D009313:National Health Programs; D009864:Ontario; D010593:Pharmaceutical Services; D010594:Pharmacies; D019338:Polypharmacy; D012959:Socioeconomic Factors
keywords: Community; Elderly; Medication review; Pharmacy; Predictors