Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial

Abstract

Background: Medication review with follow-up (MRF) is a service where community pharmacists undertake a medication review with monthly follow-up to provide continuing care. The ConSIGUE Program assessed the impact and implementation of MRF for aged polypharmacy patients in Spanish Community Pharmacies. The present paper reports on the clinical impact evaluation phase of ConSIGUE.
 Objective: The main objective of the study was to measure the effect of MRF on the primary outcome of the number of uncontrolled health problems. Secondary objectives were to analyze the drug-related problems (DRPs) identified as potential causes of ineffective or unsafe medications and the pharmacists’ interventions implemented during MRF provision.
 Methods: An open-label multi-centered cluster randomized study with comparison group (CG) was carried out in community pharmacies from 4 provinces in Spain during 6 months. The main inclusion criteria were patients over 64 years old, using 5 or more medicines. The intervention group (IG) received the MRF service (advanced medication review-type 3 MR) whereas patients in the CG received usual care.
 Results: 178 pharmacies recruited 1403 patients (IG= 688 patients; CG= 715 patients). During the 6 months of the study 72 patients were lost to follow up. The adjusted multi-level random effects models showed a significant reduction in the number of uncontrolled health problems over the periods in the IG (-0.72, 95% CI: -0.80, -0.65) and no change in the CG (-0.03, 95%CI: -0.10, 0.04). Main DRPs identified as potential causes of failures of uncontrolled health problems’ treatment were undertreated condition (559 DRPs; 35.81%), lack of treatment adherence (261 DRP; 16.67%) and risk of adverse effects (207 DRPs; 13.53%). Interventions performed by pharmacist to solve DRP mainly included the addition (246 interventions; 14.67%) and change (330 interventions; 19.68%) of a medicine and educational interventions on medicine adherence (231 interventions; 13.78%) and non-pharmacological interventions (369 interventions; 22.01%).
 Conclusions: This study provides evidence of the impact of community pharmacist on clinical outcomes for aged patients. It suggests that the provision of an MRF in collaboration with general medical practitioners and patients contributes to the improvement of aged polypharmacy patients’ health status and reduces their problems related with the use of medicines.

Polypharmacy among older Brazilians: prevalence, factors associated, and sociodemographic disparities (ELSI-Brazil)

“…Optimizing care for polypharmacy with valid and applicable measures is essential to improve health outcomes. 32 Inappropriate polypharmacy among older Brazilians could be addressed with better medication review practices. Previous studies have shown that medication review is one of the fundamental strategies for improving adherence and reducing unnecessary polypharmacy.…”

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

“…We can reasonably conclude that the more health needs medicines covered by FCPMs could meet, the more likely FCPMs changed the inequality. The geographical accessibility of designated health facilities [32], qualification of health professionals and pharmacists at these facilities [33,34], and supports from families and social network [31,35] were also the factors that could not be ignored.…”

Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis

“…Overall, four studies were judged to have a low risk of bias, seven studies were judged to have some concerns regarding the level of risk, and two studies had a high risk of bias. Five studies raise some concerns regarding potential biases in the randomization process [28][29][30][31][32]. All studies did not deviate from intended interventions.…”

“…Only one study reported some concerns regarding biases on missing outcome data [33]. Two studies did not report a measurement of outcome [32,34]. Some studies were judged to have a selection of reporting biases but were judged to have "some concerns" [28][29][30][31][32][33]35,36].…”

“…Two studies did not report a measurement of outcome [32,34]. Some studies were judged to have a selection of reporting biases but were judged to have "some concerns" [28][29][30][31][32][33]35,36]. Comprehensive medication reviews were initiated by interviewing older adults; screening their medication list, lab values, and complementary medicines; and a pharmacotherapeutic plan was decided [28,[30][31][32]34,35,37].…”