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Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study

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Abstract

Background

Polypharmacy in the Swedish elderly population is currently a prioritised area of research with a focus on reducing the use of potentially inappropriate medications (PIMs). Multi-professional interventions have previously been tested for their ability to improve drug therapy in frail elderly patients.

Objective

This study aimed to assess a structured model for pharmacist-led medication reviews in primary health care in southern Sweden and to measure its effects on numbers of patients with PIMs (using the definition of the Swedish National Board of Health and Welfare) using ≥10 drugs and using ≥3 psychotropics.

Methods

This study was a randomised controlled clinical trial performed in a group of patients aged ≥75 years and living in nursing homes or the community and receiving municipal health care. Medication reviews were performed by trained clinical pharmacists based on nurse-initiated symptom assessments with team-based or distance feedback to the physician. Data were collected from the patients’ electronic medication lists and medical records at baseline and 2 months after the medication review.

Results

A total of 369 patients were included: 182 in the intervention group and 187 in the control group. One-third of the patients in both groups had at least one PIM at baseline. Two months after the medication reviews, the number of intervention group patients with at least one PIM and the number of intervention group patients using ten or more drugs had decreased (p = 0.007 and p = 0.001, respectively), while there were no statistically significant changes in the control patients. No changes were seen in the number of patients using three or more psychotropic drugs, although the dosages of these drugs tended to decrease. Drug-related problems (DRPs) were identified in 93 % of the 182 patients in the intervention group. In total, there were 431 DRPs in the intervention group (a mean of 2.5 DRPs per patient, range 0–9, SD 1.5 at 95 % CI) and 16 % of the DRPs were related to PIMs.

Conclusions

Medication reviews involving pharmacists in primary health care appear to be a feasible method to reduce the number of patients with PIMs, thus improving the quality of pharmacotherapy in elderly patients.

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Acknowledgments

The authors especially want to thank the four pharmacists who performed the medication reviews (Annika Dobszai, Karin Fält, Martina Haggren and Krister Karlsson), the pharmacist student who initially collected the data (Susan Wong) and the municipal care nurses. We are indebted to Stephen Gilliver for his expertise and invaluable advice in proofreading the manuscript.

Conflict of interest

None declared

Disclaimer

The opinions or assertions in this article are the views of the authors and are not to be construed as official or as necessarily reflecting the views of the Swedish Medical Products Agency, where one of the authors is employed.

Funding

The study was conducted with government funding for projects involving improvement of drug therapy in the elderly.

Author information

Authors and Affiliations

  1. Laröd Health Care Centre, Helsingborg, Sweden

    Veronica Milos

  2. Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden

    Veronica Milos, Ulf Jakobsson & Patrik Midlöv

  3. Brösarp Health Care Centre, Brösarp, Sweden

    Eva Rekman

  4. Department of Medicines Management and Informatics, Kristianstad, Region Skåne, Sweden

    Åsa Bondesson

  5. Clinical Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden

    Åsa Bondesson & Tommy Eriksson

  6. Apoteket Farmaci AB, Stockholm, Sweden

    Tommy Eriksson

  7. Medical Products Agency, Department of Rational Use of Medicines, Uppsala, Sweden

    Tommy Westerlund

  8. Sahlgrenska Academy, Institute of Medicine, Department of Public Health and Community Medicine, Unit of Social Medicine, University of Gothenburg, Gothenburg, Sweden

    Tommy Westerlund

  9. Faculty of Medicine, Lund University Department of Clinical Sciences Malmö Clinical Research Centre (CRC), Building 28, Floor 11, Jan Waldenströms gata 35, Skåne University Hospital, 205 02, Malmö, Sweden

    Veronica Milos

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  1. Veronica Milos
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Correspondence to Veronica Milos.

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Milos, V., Rekman, E., Bondesson, Å. et al. Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study. Drugs Aging 30, 235–246 (2013). https://doi.org/10.1007/s40266-013-0057-0

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