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Letters to the Editor
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Medication review
Pharmacists can potentially prevent hospital admissions
From Mrs C. A. Brown, MRPharmS
In response to the results
of the POLYMED trial (PJ, 7 April, p387),
which showed no clear health gain, no difference in hospital or care
home admission but a slight decrease in the mean number of prescriptions
per patient, I would like to describe a domiciliary clinical medication
review service undertaken in a practice in South Huddersfield which,
in contrast, showed clear health gains.
This was a service to housebound patients. Most were over 75 years of
age, and many had multiple conditions and complex needs. The objectives
of the service were to improve patients’ understanding of their
medicines, to increase adherence and compliance, to optimise the medication
prescribed in a cost-effective manner and to reduce waste. The patients
for review were selected by GPs and the pharmacist had full access to
patients’ notes.
The reviews were face-to-face clinical medication reviews; a holistic
review of the patient, drawing together medication (including over-the-counter
medicines and homoeopathic and herbal medicines) prescribed by a variety
of practitioners, and incorporating lifestyle and social issues in relation
to his or her medical conditions. On returning to the surgery, patients
discussed the reviews with their GPs and suggestions were actioned. The
pharmacist entered the medication review in the patient’s electronic
notes.
One hundred and seventy-five patients were reviewed annually. Outcomes
were measured by classifying the medication changes, noting referrals,
and costing increase and decrease of prescribing.
An average of three clinically significant interventions were made per
patient and over 95 per cent of changes were accepted by the GPs. There
was a net reduction in cost of medication. A panel of GPs critically
assessed a cohort of 32 patients and, in their opinion, six potential
admissions had been prevented, the annual medication costs saved were £2,956
and the cost of medication initiated was £2,177.
Taking into account potential admissions and GP time saved, reduction
in medication costs and pharmacist time the overall cost saved per domiciliary
visit was £536.
Feedback from questionnaires to patients and GPs showed great enthusiasm
for the service. The initial objectives of the service were met but there
was a secondary outcome of potentially avoiding hospital admissions,
which is now a key objective in practice-based commissioning. The service
required the clinical pharmacist to be integrated within the existing
medication review system and involved building relationships with a range
of other health professionals.
The ideal requirements for a pharmacist medication review to be clinically
effective are a face-to-face review with the patient and full access
to the patient records. The pharmacist should have appropriate clinical
training and be working within an integrated medication review system
with other health professionals.
Use of a clinical pharmacist for domiciliary medication review maximises
the use of skill mix within the primary care team and improves health
outcomes for elderly patients with long-term conditions.
Carole Brown
Domiciliary Review Pharmacist
Calderdale Primary Care Trust
Correction
The second sentence of the third paragraph should read: "On returning to the surgery, pharmacists discussed the reviews with the GP and suggestions were actioned." |
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The
Pharmaceutical Journal