Implementation of medication reviews in community pharmacies and their effect on potentially inappropriate drug use in elderly patients

BACKGROUND: In 2008 recommendations were launched to prevent medication-related hospital admissions in the Netherlands. Elderly patients using several drugs on a chronic basis were among the target group. Pharmacy-led medication reviews (MRs) were identified as having potential for improving patient safety. OBJECTIVE: This observational study evaluated the implementation success rate of performing all five steps of a complete MR for patients and changes in the presence of nine issues of potentially inappropriate medication (PIM) use. This change was compared between patients with a complete MR (intervention group, IG) and a reference group (RG) who attended the same pharmacy; all patients were eligible for MR, but only selected patients formed the IG. SETTING: Dutch community pharmacy. METHOD: After appropriate training, the rate of IG with complete MRs was measured by pharmacists registering the various MR steps in the MR tool. Patients were eligible for a MR if aged >/= 65 years with >/= 5 drugs being used chronically. MAIN OUTCOME MEASURES: The success rate of implementing MRs with five steps completed; the presence of nine PIMs for both study groups. RESULTS: In pharmacies with specifically trained pharmacists, 63 % of selected patients received a complete MR. This was 12 % higher than in pharmacies without trained pharmacists. PIMs reported at study start declined in the IG and at study end had decreased by an average of 19 % (with a range between 34 and 100 % per PIM); this decrease did not significantly differ from the RG. CONCLUSION: Additional efforts are needed to improve the implementation of pharmacist-led MRs in order to realize its full potential in general practice, and for a substantial decrease of PIMs to occur in susceptible patients. These efforts should focus on training courses and additional support using computerized systems to share information with GPs and to register MR activities, together with sufficient financial reimbursement