Br J Clin PharmacolBritish Journal of Clinical Pharmacology DOI:10.1111DOI:10. /j.1365DOI:10. -2125DOI:10. .2004 AimsTo examine the effectiveness of a multidisciplinary service model delivering medication review to patients at risk of medication misadventure in the community. MethodsThe study was carried out in three Australian states; Queensland, New South Wales and Western Australia, and conducted as a randomized, controlled effectiveness trial with the general practitioner (GP) as the unit of randomization. In total, 92 GPs, 53 pharmacists and 400 patients enrolled in the study. The multidisciplinary service model consisted of GP education, patient home visits, pharmacist medication reviews, primary healthcare team conferences, GP implementation of action plans in consultation with patients, and follow-up surgery visits for monitoring. Effectiveness was assessed using the four clinical value compass domains of (i) functional status, (ii) clinical outcomes, (iii) satisfaction and (iv) costs. The domains of functional status (assessed by the health-related quality of life measure SF-36 subscales) and clinical outcomes (as assessed by adverse drug events (ADEs), number of GP visits, hospital services and severity of illness) were measured at baseline and endpoint. Satisfaction was measured by success in implementation and by participant satisfaction at endpoint, and costs (as assessed using medication and healthcare service costs, less intervention costs) were measured preintervention and during the trial. In addition, process evaluation was conducted for intervention patients, in which problems and recommendations from the medication reviews were described. ResultsThe model was successfully implemented with 92% of intervention GPs suggesting that the model had improved the care of participating patients, a view shared by 94% of pharmacists. In addition, positive trends in clinical outcomes (ADEs and severity of illness) and costs (an ongoing trend towards reduction in healthcare service costs) were evident, although the trial was limited to a 6-month intervention time. No differences between intervention and control groups were identified for the healthrelated quality of life domain. The cost-effectiveness ratio for the intervention based on cost savings, reduced adverse events and improved health outcomes was small. The most common problems identified in the medication reviews were potential adverse drug reactions, suboptimal monitoring and adherence/lack of concordance issues. In total, 54.4% of recommendations were enacted, and 23.9% were implemented precisely as recommended in the medication review. Follow-up evaluation showed that 70.9% of actions had a positive outcome, 15.7% no effect and 3.7% had a negative outcome. Medication reviews in the communityBr J Clin Pharmacol 58 :6 649 ConclusionsMost studies emphasize efficacy and the best achievable clinical outcomes rather than whether an intervention will be effective in practice. The current trial showed that three of the four domains in the clinical va...

Aims To evaluate whether a year long clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews could change drug use, mortality and morbidity in nursing home residents. Methods A cluster randomised controlled trial, where an intervention home was matched to three control homes, was used to examine the effect of the clinical pharmacy intervention on resident outcomes. The study involved 905 residents in 13 intervention nursing homes and 2325 residents in 39 control nursing homes in southeast Queensland and north-east New South Wales, Australia. The outcome measures were: continuous drug use data from government prescription subsidy claims, crosssectional drug use data on prescribed and administered medications, deaths and morbidity indices (hospitalization rates, adverse events and disability indices). Results This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. Differences in nursing home characteristics, as de®ned by cluster analysis with SUDAAN 1 , negated intervention-related apparent signi®cant improvements in survival. The use of benzodiazepines, nonsteroidal anti-in¯ammatory drugs, laxatives, histamine H 2 -receptor antagonists and antacids was signi®cantly reduced in the intervention group, whereas the use of digoxin and diuretics remained similar to controls. Overall, drug use in the intervention group was reduced by 14.8% relative to the controls, equivalent to an annual prescription saving of $A64 per resident (approximately £25). Conclusions This intervention improved nursing home resident outcomes related to changes in drug use and drug-related expenditure. The continuing divergence in both drug use and survival at the end of the study suggests that the difference would have been more signi®cant in a larger and longer study, and even more so using additional instruments speci®c for measuring outcomes related to changes in drug use.

The findings support the theory that polypharmacy and medication-related risk factors as a result of polypharmacy are correlated to poor health outcomes.

Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.

Background: The General Level Framework (GLF) is a tool for evaluating pharmacists' performance, providing tailored feedback and training, and guiding professional development. Aim: To ascertain the changes in pharmacists' workplace performance over time using the GLF and to describe pharmacists' views on the baseline evaluation process. Method: The UK GLF was mapped against Australian pharmacy competency standards and practice guidelines. 61 of the 92 competencies from the Queensland Health version of the GLF representing core professional activities of Australian pharmacists were analysed. Trained evaluators used the adapted GLF to observe pharmacists from 18 Queensland public hospitals in their workplace (baseline and repeat) and rate the frequency with which competencies were completed to a defined standard. The evaluators then provided pharmacists with tailored feedback, encouraged self-problem solving, and identified and addressed their training needs. Pharmacists' views of the baseline evaluation process was assessed using a 7-point rating scale. Results: 66 pharmacists from 18 Queensland hospitals underwent the evaluation. At baseline, pharmacists had a median of 3 (1 to 10) years hospital experience. A median of 14 (5 to 22) months lapsed between baseline and repeat observations. Of the 61 competencies analysed, 35 (57%) competencies showed a significant improvement from baseline to repeat observations (p ≤ 0.05). Competencies that improved significantly from baseline included: aspects of medication history taking; medication management; identification, documentation and resolution of drug-related problems; appraisal of therapeutic options; and communication with doctors and nurses. For 9 (15%) competencies, pharmacists were already performing at the maximum level (median score 4) at baseline and no change was recorded between observations. No competency demonstrated a decrease in performance between observations. When the mean scores with 95% confidence intervals for the clusters of competencies were compared over time all the mean scores except for discharge

Visiting patients' homes may identify medication-related risk factors not otherwise apparent through patient visits to the health practitioner when medications may be brought for review (i.e. 'brown bag' reviews).

ObjectivesCurrent evidence to support non-medical prescribing is predominantly qualitative, with little evaluation of accuracy, safety and appropriateness. Our aim was to evaluate a new model of service for the Australia healthcare system, of inpatient medication prescribing by a pharmacist in an elective surgery preadmission clinic (PAC) against usual care, using an endorsed performance framework.DesignSingle centre, randomised controlled, two-arm trial.SettingElective surgery PAC in a Brisbane-based tertiary hospital.Participants400 adults scheduled for elective surgery were randomised to intervention or control.InterventionA pharmacist generated the inpatient medication chart to reflect the patient's regular medication, made a plan for medication perioperatively and prescribed venous thromboembolism (VTE) prophylaxis. In the control arm, the medication chart was generated by the Resident Medical Officers.Outcome measuresPrimary outcome was frequency of omissions and prescribing errors when compared against the medication history. The clinical significance of omissions was also analysed. Secondary outcome was appropriateness of VTE prophylaxis prescribing.ResultsThere were significantly less unintended omissions of medications: 11 of 887 (1.2%) intervention orders compared with 383 of 1217 (31.5%) control (p<0.001). There were significantly less prescribing errors involving selection of drug, dose or frequency: 2 in 857 (0.2%) intervention orders compared with 51 in 807 (6.3%) control (p<0.001). Orders with at least one component of the prescription missing, incorrect or unclear occurred in 208 of 904 (23%) intervention orders and 445 of 1034 (43%) controls (p<0.001). VTE prophylaxis on admission to the ward was appropriate in 93% of intervention patients and 90% controls (p=0.29).ConclusionsMedication charts in the intervention arm contained fewer clinically significant omissions, and prescribing errors, when compared with controls. There was no difference in appropriateness of VTE prophylaxis on admission between the two groups.Trial RegistrationRegistered with ANZCTR—ACTR Number ACTRN12609000426280

Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.