UK study fails to show benefits of medication reviews
The appropriateness of a patient's drug treatment does not improve significantly after a programme of pharmaceutical care, including monthly medication reviews, a UK study has shown. However, the study's lead investigator has questioned the sensitivity of tools used to measure clinical outcomes that result from such interventions.
Ian Wong, Department of Health public health career scientist at the
School of Pharmacy, University of London, presented findings from the
RESPECT pharmaceutical care trial at the ninth Commonwealth
Pharmaceutical Association conference held in Kuala Lumpur, Malaysia, last week. The
as yet unpublished study is the first in the UK to evaluate the effectiveness
of medication reviews conducted by a patient’s usual community
pharmacist.
The study was an interrupted time series trial in which five primary
care trusts implemented pharmaceutical care at quarterly intervals and
in random order. It involved 760 patients aged 75 years and over
who were prescribed at least five repeat medicines.
“We followed patients, who also acted as their own controls, for
36 months between recruitment and final visit, including 12 months when
they were
receiving pharmaceutical care,” Professor Wong said.
After training, pharmacists interviewed patients at the community pharmacy
and developed a pharmaceutical care plan that was shared with the patient’s
GP. Monthly medication reviews were conducted for one year. The appropriateness
of patients’ medication was scored using the UK Medication Appropriateness
Index (UK-MAI) — a score of 0 indicates that a medicine is completely
appropriate, a score of 20 indicates that a medicine is completely inappropriate.
“Overall, we saw the mean UK-MAI score going down, so it was improving.
But this was only a trend,” reported Professor Wong, adding that
the reduction was small and not statistically significant.
The pharmaceutical care intervention also had no significant effects
on the number of hospital admissions, the number of GP clinic consultations,
mortality rate or quality of life scores.
Professor Wong presented the findings alongside those from other UK studies
of medication reviews. He concluded that pharmacists are able to identify
pharmaceutical care issues and initiate change. However, he argued that
because community pharmacists already provide pharmaceutical care to
all patients, in the form of interventions, it is difficult to show positive
effects from medication reviews. “To change from good to very good
is difficult,” he said.
Professor Wong also put the lack of positive results from UK studies
down to the insensitivity of instruments used to measure changes in clinical
outcomes. And he questioned whether the design of studies is appropriate. “Are
we measuring the right things,” he asked. “We are trying
to generalise, taking every patient regardless of whether they need pharmaceutical
care.” He suggested that identifying a need for pharmaceutical
care would be a sensible first step in future studies.
A report of the Commonwealth Pharmaceutical
Association conference will
be published by The Pharmaceutical Journal in September 2007.
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