Objective. To determine whether a pharmacist-led medications review in primary care reduces the number of drugs and the number of drug-related problems. Design. Prospective randomized controlled trial. Setting. Liljeholmen Primary Care Centre, Stockholm, Sweden. Subjects. 209 patients aged ≥ 65 years with five or more different medications. Intervention. Patients answered a questionnaire regarding medications. The pharmacist reviewed all medications (prescription, non-prescription, and herbal) regarding recommendations and renal impairment, giving advice to patients and GPs. Each patient met the pharmacist before seeing their GP. Control patients received their usual care. Main outcome measures. Drug-related problems and number of drugs. Secondary outcomes included health care utilization and self-rated health during 12 months of follow-up. Results. No significant difference was seen when comparing change in drug-related problems between the groups. However, a significant decrease in drug-related problems was observed in the intervention group (from 1.73 per patient at baseline to 1.31 at follow-up, p < 0.05). The change in number of drugs was more pronounced in the intervention group (p < 0.046). Intervention group patients were not admitted to hospital on fewer occasions or for fewer days, and there was no significant difference between the two groups regarding utilization of primary care during follow-up. Self-rated health remained unchanged in the intervention group, whereas a drop (p < 0.02) was reported in the control group. This resulted in a significant difference in change in self-rated health between the groups (p < 0.047). Conclusions. The addition of a skilled pharmacist to the primary care team may contribute to reductions in numbers of drugs and maintenance of self-rated health in elderly patients with polypharmacy.

BackgroundDrug use among the elderly population is generally extensive and the use of potentially inappropriate medications (PIMs) is common, which increases the risk for drug-related problems (DRP). Medication reviews are one method to improve drug therapy by identifying, preventing and solving DRPs.The aim of this study was to evaluate the effect of medication reviews on total drug use and potentially inappropriate drug use in elderly patients, as well as describe the occurrence and types of drug-related problems.MethodThis was a cross-sectional analysis to study medication reviews conducted by trained clinical pharmacists followed by team-based discussions with general practitioners (GPs) and nurses, for elderly primary care patients in Skåne, Sweden. Included in the analysis were patients ≥75 years living in nursing homes or in their own homes with home care, who received a medication review during 2011–2012. Documented DRPs were described as both the type of DRPs and as pharmacists’ recommendations to the GP. The usage of ≥3 psychotropics and PIMs (antipsychotics, anticholinergics, long-acting benzodiazepines, tramadol and propiomazine) at baseline and after medication review were also studied.ResultsThe analysis included a total of 1720 patients. They were on average aged 87.5 years, used typically 11.3 drugs (range 1–35) and 61% of them used 10 drugs or more. Of the patients, 84% had at least one DRP with a mean of 2.2 DRPs/patient. Of the DRPs, 12% were attributable to PIMs. The proportion of patients with ≥ one PIM was reduced significantly (p < 0.001) as was the use of ≥3 psychotropics (p < 0.001). The most common DRP was unnecessary drug therapy (39%), followed by dose too high (21%) and wrong drug (20%). Drug withdrawal was the most common result.ConclusionThis study shows that medication reviews performed in everyday care are one way of improving drug use among elderly patients. The use of potentially inappropriate medications and use of three or more psychotropic drugs decreased after the medication review. Our study also shows that drug use is extensive in nursing home residents and elderly patients with homecare, and that unnecessary drug therapy is a common problem.