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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR28

Comparison of pharmacist-run medication review clinics using different patient selection criteria

By J. D. Morgan, D. J. Wright and H. Chrystyn

Introduction The majority of pharmacist-run repeat prescribing medication review clinics have used the number of regular prescription items as the method of patient identification.1-3 Using such an indiscriminate method of identification can result in unnecessary consultations. It may be more appropriate to identify patients who are prescribed drugs with known potential for causing medication-related problems, eg, diuretics.2 Diuretics are known to be associated with adverse effects such as metabolic disturbances.4,5
The aim of this study was to compare the results of pharmacist-run medication review clinics using either the number of prescription items or prescriptions for diuretics as patients identifiers.

Method Pharmacist-run medication review clinics were carried out in two general medical practices within the same primary care group. Repeat prescription of at least five items was used to identify patients in Clinic 1 and prescription for diuretics other than frusemide or bendrofluazide 2.5mg alone was used in Clinic 2.
Medication reviews were carried out using a semi-structured interview technique. Monitoring of serum electrolytes, serum drug concentrations and blood pressure was carried out by the pharmacist when necessary. Patients unable to attend the surgery were visited at home. Each review was subsequently discussed with the appropriate GP and agreed changes implemented.
All potential interventions were classified arbitrarily as either administrative or clinical. Prescribing cost savings were calculated and compared with the estimated cost for providing the service.

Focal points

  • Most previous studies hav used the number of prescription items as the patient selection criterion for medication review but this may not be the best method of identification
  • Two pharmacist-run medication review clinics were carried out using patient selection by number of prescription items in one clinic and diuretic prescriptions in the other
  • The types of interventions were similar in the two clinics
  • Proportions of patients for which no clinical interventions were suggested were low, suggesting few unnecessary reviews
  • Better promotion of rational prescribing to GPs and more efficient management of repeat prescribing systems may have made the clinics unnecessary

Results A total of 97 patients was seen in Clinic 1 and 50 in Clinic 2. The mean (SD) ages were 71.0 (11.0) and 69.7 (10.9) years respectively; 66.3 per cent and 78.2 per cent of patients were female. The age and sex distributions of the two clinics were not significantly different.
Table 1 provides a summary of the results from both clinics. For only six (6.2 per cent) and three (6.0 per cent) of Clinic 1 and 2 patients, respectively, were there no clinical interventions. Twenty-five (26 per cent) and 27 (54 per cent) patients in Clinics 1 and 2, respectively, required blood pressure monitoring and 32 (33 per cent) and 18 (36 per cent) required blood sampling to assess renal/hepatic/thyroid function, electrolytes, cholesterol or serum drug levels.

Table 1

Discussion and conclusions The types of interventions generated from the medication reviews were similar in the two clinics. The numbers of patients for whom no clinical interventions were made were low and similar in the two clinics, suggesting that there were few unnecessary consultations.
Although the annual drug cost savings generated from Clinic 1 were greater, this was not statistically significant; this may be a type II error due to small sample size.
To demonstrate the true value of using the two methods of patient identification, further work to describe and compare the clinical consequences of non-intervention is required.
Better promotion of rational prescribing to GPs and more efficient management of repeat prescribing systems may have made the clinics unnecessary.

School of pharmacy, University of Bradford

References

1. Burtonwood AM, Hinchliffe AL, Tinkler GG. A prescription for quality: a role for the clinical pharmacist in general practice. Pharm J 1998;261:678-80.
2. Sykes D, Westwood P, Gilleghan J. Development of a review programme for repeat prescription medicines. Pharm J 1996;256:458-60.
3. Goldstein R, Hulme H, Willits J. Reviewing repeat prescribing: general practitioners and community pharmacists working together. Int J Pharm Prac 1998;6:60-6.
4. Baglin A, Boulard J-C, Hanslik T, Prinseau J. Metabolic adverse reactions to diuretics - clinical relevance to elderly patients. Drug Safety 1995;12:161-67.
5. Hyams DE. The elderly patient: a special case for diuretic therapy. Drugs 1986;31 Suppl 4;138-51.