Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial
Metadatos
Mostrar el registro completo del ítemAutor
Varas Doval, Raquel; Gastelurrutia, Miguel Ángel; Benrimoj, Shalom Isaac; Martínez Martínez, FernandoEditorial
CENTRO INVESTIGACIONES & PUBLICACIONES FARMACEUTICAS
Materia
Medication Therapy Management Community Pharmacy Services Pharmacies Pharmacists Polypharmacy Treatment Adherence and Compliance Randomized Controlled Trials as Topic Spain
Fecha
2020Referencia bibliográfica
Varas-Doval R, Gastelurrutia MA, Benrimoj SI, García-Cárdenas V, Sáez-Benito L, Martinez-Martínez F. Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial. Pharmacy Practice 2020 Oct-Dec;18(4):2133. [https://doi.org/10.18549/PharmPract.2020.4.2133]
Patrocinador
Cinfa LaboratoriesResumen
Background: Medication review with follow-up (MRF) is a service where community pharmacists undertake a medication review with
monthly follow-up to provide continuing care. The ConSIGUE Program assessed the impact and implementation of MRF for aged
polypharmacy patients in Spanish Community Pharmacies. The present paper reports on the clinical impact evaluation phase of
ConSIGUE.
Objective: The main objective of the study was to measure the effect of MRF on the primary outcome of the number of uncontrolled
health problems. Secondary objectives were to analyze the drug-related problems (DRPs) identified as potential causes of ineffective
or unsafe medications and the pharmacists’ interventions implemented during MRF provision.
Methods: An open-label multi-centered cluster randomized study with comparison group (CG) was carried out in community
pharmacies from 4 provinces in Spain during 6 months. The main inclusion criteria were patients over 64 years old, using 5 or more
medicines. The intervention group (IG) received the MRF service (advanced medication review-type 3 MR) whereas patients in the CG
received usual care.
Results: 178 pharmacies recruited 1403 patients (IG= 688 patients; CG= 715 patients). During the 6 months of the study 72 patients
were lost to follow up. The adjusted multi-level random effects models showed a significant reduction in the number of uncontrolled
health problems over the periods in the IG (-0.72, 95% CI: -0.80, -0.65) and no change in the CG (-0.03, 95%CI: -0.10, 0.04). Main DRPs
identified as potential causes of failures of uncontrolled health problems’ treatment were undertreated condition (559 DRPs; 35.81%),
lack of treatment adherence (261 DRP; 16.67%) and risk of adverse effects (207 DRPs; 13.53%). Interventions performed by pharmacist
to solve DRP mainly included the addition (246 interventions; 14.67%) and change (330 interventions; 19.68%) of a medicine and
educational interventions on medicine adherence (231 interventions; 13.78%) and non-pharmacological interventions (369
interventions; 22.01%).
Conclusions: This study provides evidence of the impact of community pharmacist on clinical outcomes for aged patients. It suggests
that the provision of an MRF in collaboration with general medical practitioners and patients contributes to the improvement of aged
polypharmacy patients’ health status and reduces their problems related with the use of medicines.