Effects of a pharmacist-led structured medication review in primary care on drug-related
problems and hospital admission rates: a randomized controlled trial
Sammanfattning
Objective. To determine whether a pharmacist-led medications review in primary care reduces
the number of drugs and the number of drug-related problems. Design. Prospective randomized
controlled trial. Setting. Liljeholmen Primary Care Centre, Stockholm, Sweden. Subjects. 209 patients
aged ? 65 years with five or more different medications. Intervention. Patients answered a
questionnaire regarding medications. The pharmacist reviewed all medications (prescription, non-
prescription, and herbal) regarding recommendations and renal impairment, giving advice to patients
and GPs. Each patient met the pharmacist before seeing their GP. Control patients received their
usual care. Main outcome measures. Drug-related problems and number of drugs. Secondary
outcomes included health care utilization and self-rated health during 12 months of follow-up.
Results. No significant difference was seen when comparing change in drug-related problems
between the groups. However, a significant decrease in drug-related problems was observed in the
intervention group (from 1.73 per patient at baseline to 1.31 at follow-up, p < 0.05). The change in
number of drugs was more pronounced in the intervention group (p < 0.046). Intervention group
patients were not admitted to hospital on fewer occasions or for fewer days, and there was no
significant difference between the two groups regarding utilization of primary care during follow-up.
Self-rated health remained unchanged in the intervention group, whereas a drop (p < 0.02) was
reported in the control group. This resulted in a significant difference in change in self-rated health
between the groups (p < 0.047). Conclusions. The addition of a skilled pharmacist to the primary care
team may contribute to reductions in numbers of drugs and maintenance of self-rated health in
elderly patients with polypharmacy.