Medicines Management
Issue no 5, p3
September/October 2002

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Pharmacist-led review a success

Pharmacist-led medication reviews of elderly patients following their admission to hospital result in more appropriate prescribing, researchers have found. Following strict protocols for medication review and history taking, they found that improvements such as discontinuation of drugs no longer required or contraindicated, avoidance of adverse drug reactions, and tailoring of therapy to patients' needs were made.

The research team, from the Centre for Health Studies at Durham University, developed the protocols published evidence, and from some preliminary work they carried out at North Durham NHS Health Care Trust. This involved reviewing patients' notes, informal discussions with staff and patients, and piloting the protocols before the main study.

The protocols were then evaluated by a pharmacist on a total of 90 patients from two acute medical wards of the hospital. The pharmacist found that the number of drugs taken by this group of patients as a whole was 678, compared with 477 according to data that had been collected by the admitting doctor. Half of the patients in the study were taking non-prescription drugs, none of which had been recorded by the admitting doctor.

As a result of the review, a total of 144 changes to patients' medication regimens were made. Of these, 84 were medicine discontinuations, 50 were medicines added to existing regimens and 12 were dose changes of existing medications.

The researchers stress the importance of reviewing over-the-counter medicine use among the elderly after admission to hospital, as they say these products have the potential to cause serious adverse effects in this cohort of patients.

The research (PDF 55k) was presented at this year's British Pharmaceutical Conference in Manchester, and published in the IJPP (2002;10(suppl):R58).