Medicines Management
Issue no 5, p4
September/October 2002

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Second medication review good for the elderly

A second medication review identifies additional clinical interventions and benefits elderly patients, say researchers.

Duncan Petty and colleagues at the Pharmacy Practice and Medicines Management Group, Leeds University, found that 184 medicine changes were made to the therapy of a group of elderly patients between their first and second medication reviews. Forty of the changes were recommended by the pharmacist at the initial review, 22 patients had an intervention in their treatment at the first review only, 17 patients at the second review and nine patients at both reviews.

The study attempted to determine whether following recommendations in the National Service Framework for Older People would result in additional clinical interventions. The NSF suggests people aged 75 years and over should have an annual medication review and those on four or more medicines should be reviewed six monthly.

The authors conclude that although fewer patients require treatment intervention at their second review, pharmacists continue to identify clinical issues. They say that patients taking four or more medicines are more likely than those taking fewer medicines to receive an intervention at the first and second review (PDF 45K), although the proportion is less at the subsequent review (IJPP 2002; 10(suppl): R70).

The research team had previously undertaken a trial of pharmacist-conducted medication reviews in four GP practices (BMJ 2001;323:1340–3), and patients from this first trial were invited for a second review 18 months after their initial appointment. Fifty patients aged 65 years or over, taking at least one repeat medicine, were given a second review in this latest study. Professor Theo Raynor, co-researcher, explained that the list of medicines patients were taking at the time of the second review more closely reflected what the doctor thought they were taking than it did at the first review. "This shows that problems were resolved at the first review," he said.

However, he added that the second review did identify other issues that had occurred in the meantime. "The NSF for Older People said that reviews should be carried out regularly and our findings confirm that this is appropriate. Whether these reviews should be carried out every six months or every year is still an open question," Professor Raynor concluded.