Pharmacist-Led Medication Reviews to Identify and Collaboratively Resolve Drug-Related Problems in Psychiatry – A Controlled, Clinical Trial

Abstract

Aim of the studyThis prospective, controlled trial aimed to assess the effect of pharmacist-led medication reviews on the medication safety of psychiatric inpatients by the resolution of Drug-Related Problems (DRP). Both the therapy appropriateness measured with the Medication Appropriateness Index (MAI) and the number of unsolved DRP per patient were chosen as primary outcome measures.MethodsDepending on their time of admission, 269 psychiatric patients that were admitted to a psychiatric university hospital were allocated in control (09/2012-03/2013) or intervention group (05/2013-12/2013). In both groups, DRP were identified by comprehensive medication reviews by clinical pharmacists at admission, during the hospital stay, and at discharge. In the intervention group, recommendations for identified DRP were compiled by the pharmacists and discussed with the therapeutic team. In the control group, recommendations were not provided except for serious or life threatening DRP. As a primary outcome measure, the changes in therapy appropriateness from admission to discharge as well as from admission to three months after discharge (follow-up) assessed with the MAI were compared between both groups. The second primary outcome was the number of unsolved DRP per patient after completing the study protocol. The DRP type, the relevance and the potential of drugs to cause DRP were also evaluated.ResultsThe intervention led to a reduced MAI score by 1.4 points per patient (95% confidence interval [CI]: 0.8–2.0) at discharge and 1.3 points (95% CI: 0.7–1.9) at follow-up compared with controls. The number of unsolved DRP in the intervention group was 1.8 (95% CI: 1.5–2.1) less than in control.ConclusionThe pharmaceutical medication reviews with interdisciplinary discussion of identified DRP appears to be a worthy strategy to improve medication safety in psychiatry as reflected by less unsolved DRP per patient and an enhanced appropriateness of therapy. The promising results of this trial likely warrant further research that evaluates direct clinical outcomes and health-related costs.Trial RegistrationDeutsches Register Klinischer Studien (DRKS), DRKS00006358

Clinical and economic outcomes of hospital pharmaceutical care: A systematic review and meta-analysis

“…Though identifying, solving and preventing medication problems, finding out prescription errors and medication-related injuries by clinical pharmacists, incidence of adverse events and rehospitalization rates could be reduced. Patient adherence of the treatment could be significantly improved and possible harm due to medication problems had been reduced after patients received their medication instructions 2 . Medication education and treatment advice from clinical pharmacists could also shorten hospital stay 3 .…”

In Reply

“…The intervention measures were adapted to the requirements of doctors in private practice after optimized communication with the hospitals. We did not aim to study the effect of individual modules or to evaluate the benefit of medication checks; other studies have already done so (1,2). Studies that were conducted in non-German speaking countries have shown that multifactorial problems at interfaces can be solved quickly by combining several measures in medication management (3).…”

Effects Are not Clear

“…The intervention measures were adapted to the requirements of doctors in private practice after optimized communication with the hospitals. We did not aim to study the effect of individual modules or to evaluate the benefit of medication checks; other studies have already done so (1,2). Studies that were conducted in non-German speaking countries have shown that multifactorial problems at interfaces can be solved quickly by combining several measures in medication management (3).…”