Are interventions recommended by pharmacists during Home Medicines Review evidence‐based?

Abstract

The majority of the actions recommended by pharmacists during the medication review process were consistent with the literature embedded in key Australian information sources. Medication management in older people is complex and challenging, as highlighted by the DRPs identified in 98% of our patients. A suitably trained pharmacist, with full access to the patient, medical record and supporting resources, can help to improve the quality use of medicines in this at-risk population.

Education and Assessment of Pharmacists on the Use of the Drug Burden Index in Older Adults Using a Continuing Professional Development Education Method

“…5 Recommendations provided by a pharmacist during the medication review are evidence-based and improve outcomes such as adherence and reduction in the number of falls among older adults. [6][7][8] The Drug Burden Index (DBI) is a pharmacological risk assessment tool that measures a patient's total exposure to medications with anticholinergic and sedative properties. 9 A higher DBI is associated independently with hospitalization, frailty, falls, mortality, and impairments in function necessary for independent living in older adults.…”

Time to Rethink the Funding Model for Home Medicines Review

“…One study addressing consumer perspectives of HMRs found that patients believed HMRs helped them gain information about their medicines and made them feel reassured, valued and cared for. 5,16 Moreover, it is important to note that recent Australian studies have demonstrated that referrals for HMRs are appropriately targeted to patients at highest risk of medication-related problems. 21 Research conducted across Australia has consistently demonstrated that HMRs are a cost-effective way to identify and resolve medicine-related problems and improve health outcomes.…”

“…MedsChecks, Diabetes MedsChecks and Clinical Interventions by pharmacists), none of which is supported by any evidence in the context of the Australian healthcare setting. Conversely, there is evidence on the value of HMRs to consumers, 2,5,6 a demonstration of cost savings of up to $550 per HMR to the health system, 7-10 and a demonstrable track record that clearly illustrates the delivery of a truly collaborative service between GPs, patients, independent accredited pharmacists and other community or hospitalbased pharmacists [11][12][13][14][15][16][17][18] (Fig. 1).…”

“…Australian studies have demonstrated that HMRs can resolve, manage or reduce medicine-related problems for a wide range of patients. [11][12][13][14][15][16][17][18][19][20][21] In addition, HMRs improve health outcomes; for example, in patients receiving betablockers for heart failure, an HMR resulted in a 45% reduction in likelihood of hospitalisation for heart failure at any time. 18 Another study found that an HMR in patients taking warfarin resulted in a 79% reduced likelihood of bleeding-associated hospitalisation 2-6 months after the HMR.…”

“…21 Research conducted across Australia has consistently demonstrated that HMRs are a cost-effective way to identify and resolve medicine-related problems and improve health outcomes. [11][12][13][14][15][16][17][18][19] Based on Australian data, [7][8][9][10][11][18][19][20] approximately 25 000 out of every 100 000 HMRs conducted are provided to patients with high-cost medical conditions (diabetes, heart failure and atrial fibrillation). Cost savings to the health system arising from HMRs for those 25 000 Australians can be estimated at approximately $550 per person for each HMR (from hospital costs and length of stay), totalling $13.75 million per year.…”