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Br J Clin Pharmacol. 2016 Sep;82(3):831-8. doi: 10.1111/bcp.13012. Epub 2016 Jun 9.

The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients.

Author information

1
Pharmaceutical Technology Department, University of the Basque Country, Vitoria-Gasteiz.
2
Official Pharmacist Association of Guipuzcoa, Donostia-San Sebastian, Spain.
3
Graduate School of Health, University of Technology Sydney, Sydney, Australia.
4
Internal Medicine Department, Donostia Hospital, Donostia-San Sebastian.
5
Pharmaceutical Care Research Group, University of Granada, Granada, Spain.

Abstract

AIMS:

The aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs.

METHODS:

This was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain. Pharmacies in the intervention group (IG) provided a comprehensive medication review during 6 months. Pharmacists in the comparison group (CG) delivered usual care. For the purposes of this sub-analysis, an expert panel of three internal medicine specialists screened the hospitalizations occurring during the main study, in order to identify medication-related hospitalizations. Inter-rater reliability was measured using Fleiss's kappa. Hospital costs were calculated using diagnosis related groups.

RESULTS:

One thousand four hundred and three patients were included in the main study and they had 83 hospitalizations. Forty-two hospitalizations (50.6%) were medicine-related, with a substantial level of agreement among the experts (kappa = 0.65, 95% CI 0.52, 0.78, P < 0.01). The number of medication-related hospitalizations was significantly lower in patients receiving MRF (IG 11, GC 31, P = 0.042). The probability of being hospitalized was 3.7 times higher in the CG (odds ratio 3.7, 95% CI 1.2, 11.3, P = 0.021). Costs for a medicine-related hospitalization were €6672. Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 35.9, 378.0, P = 0.018].

CONCLUSION:

MRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy.

KEYWORDS:

aged; drug utilization review; hospitalization; pharmaceutical services

PMID:
27195696
PMCID:
PMC5338122
DOI:
10.1111/bcp.13012
[Indexed for MEDLINE]
Free PMC Article

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