Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities

Abstract

Background Medication reviews contribute to protecting long-term care (LTC) residents from drug related problems (DRPs). However, few controlled studies have examined the impact on patient-relevant outcomes so far. Objective We examined the impact of a one-time, pharmacist-led medication review on medication changes (primary endpoint) including discontinued medication, the number of chronic medications, hospital admissions, falls, and deaths (secondary endpoints). Methods A prospective, controlled intervention study was performed in three LTC facilities. In the intervention group (IG), after performing a medication review, a pharmacist gave recommendations for resolving DRPs to physicians, nurses and community pharmacists. The control group (CG) received usual care without a medication review. (i) We assessed the number of medication changes and the secondary endpoints in both groups before (t0) and after (t1, t2) the intervention. (ii) Additionally, the medication review was evaluated in the IG with regard to identified DRPs, the healthcare professional’s feedback on the forwarded pharmacist recommendations and whether DRPs were finally resolved. Results 107 (IG) and 104 (CG) residents were enrolled. (i) More medication changes were identified in the IG than in the CG at t1 (p = 0.001). However, no significant difference was identified at t2 (p = 0.680). Mainly, medication was discontinued in those medication changes. Chronic medications increased in the CG (p = 0.005) at t2 while hospital admissions, falls, and deaths showed no differences. (ii) Overall, 1252 DRPs (median: 10; minimum-maximum: 2–39) were identified. Recommendations for 82% of relevant DRPs were forwarded to healthcare professionals, of which 61% were accepted or clarified. 22% were not accepted, 12% required further review and 6% remained without feedback. 51% of forwarded DRPs were finally resolved. Conclusions We found more medication changes in the IG compared to controls. Mostly, medication was discontinued. This suggests that our intervention was successful in discontinuing unnecessary medication. Other clinical outcomes such as falls, hospitalisations, and deaths were not improved due to the one-time intervention. The medication review further identified a high prevalence of DRPs in the IG, half of which were finally resolved. Trial registration German Clinical Trials Register, DRKS00026120 (www.drks.de, retrospectively registered 07/09/2021).

Extended Pharmacist Assessment of Medication Safety for Nursing Home Residents—A Cross-Sectional and Prospective Study

“…Pharmacist-led interventions have the potential to reduce the incidence of MRP in older people living in nursing homes [ 24 , 25 ]. The observed overall rate of 78.0% of MRPs detected via routine review and resolved in response to the pharmacist’s alerts correlates well with data reported by Bitter et al in 2019 and Lexow et al in 2022 for geriatric residents in German long-term care facilities [ 26 , 27 ].…”

What happens when pharmacist independent prescribers lead on medicine management in older people’s care homes: a qualitative study

“…However, the Drug Burden Index outcome significantly favoured the intervention. 18 Reduction in drug related problems is reported in another pharmacist led review intervention, 41 indicating there is potential for pharmacist led review to have some positive impacts for CH residents relating to side effects of some medicines. Further economic evaluation would be required to examine if this level of pharmacist input would be cost effective in practice.…”