The Pharmaceutical Journal Vol 267 No 7177 p805-809
8 December 2001

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Medication reviews by pharmacists are better than those done by GPs

Medication reviews conducted by primary care pharmacists result in reduced prescribing costs and higher review rates than reviews by general practitioners, a new study has shown.

A team led by Dr Arnold Zermansky of the academic pharmacy practice division, University of Leeds, found that reviews by a pharmacist were more thorough and led to more medication changes than GP reviews producing a subsequent saving of £61 per patient a year.

In addition, pharmacist reviews did not adversely affect general practitioner workload. "Extra workload [caused by increased referral for tests] was appropriate, and was balanced by a reduced workload in the subsequent months," the researchers say.

Although the study was not large enough to detect mortality differences, it did reveal a smaller number of deaths in the group of patients reviewed by a pharmacist (15 out of 608) compared with those who received normal care (25 out of 580).

Patients enrolled in the study were randomly assigned to receive medication review by a pharmacist, who invited patients for review, or to receive normal care by their GP. The pharmacist review consisted of a consultation with the patient, at which each condition being treated was discussed. Where monitoring was required, the patient was referred by the pharmacist to the practice nurse or doctor.

Almost all patients (97 per cent) assigned to the intervention group were reviewed, compared with 44 per cent of the control group patients. Patients in the intervention group were also more likely stop an existing drug (41 per cent versus 33 per cent) and less likely to have new ones prescribed (46 per cent versus 49 per cent). The researchers observed that monthly medication count and costs rose in both groups over the year but for each the rise was smaller in the intervention group.

The researchers say that the study supports the concept of medication review suggested in the National Service Framework for Older People and that a larger trial is justified (BMJ 2001;323:1340).

Richard Seal, medicines management services project team leader, National Prescribing Centre, Liverpool, welcomed the study saying: "This is just the sort of practical learning that we can put to use in the national medicines management services collaborative programme."

He added that the study showed that pharmacists can make clinically important decisions that will have a real impact on patients’ lives. Helping to control drug costs and reducing the burden of work placed on other health care professionals were valuable additional benefits

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