Are interventions recommended by pharmacists during Home Medicines Review evidence-based?
Castelino, RL and Bajorek, BV and Chen, TF, Are interventions recommended by pharmacists during Home Medicines Review evidence-based?, Journal of Evaluation in Clinical Practice, 17, (1) pp. 104-110. ISSN 1356-1294 (2011) [Refereed Article]
Introduction Over the past decade medication review services have been implemented in
many countries, including Australia, UK and USA. Although, the attitudes and barriers to
the implementation of evidence-based medicine have been investigated, the extent to which
medication review recommendations are evidence-based is not known.
Objective To determine (1) the extent to which pharmacist’s recommendations during
medication review services were consistent with the evidence-based guides at the time of
the review; and (2) the nature and extent of drug-related problems (DRPs) and the actions
recommended by pharmacists to resolve DRPs.
Method A retrospective review of Home Medicines Review cases performed on 224
community-dwelling older people (65 years or older). The chi-squared test for categorical
variables was used to compare the proportion of recommendations that were evidencebased
and recommendations for which no evidence could be identified in the most common
Australian information sources. DRPs and the actions recommended to resolve the DRPs
were classified according to previously employed criteria.
Results Pharmacists made a total of 1114 therapeutic recommendations to general practitioners,
of which 964 required supporting pharmacotherapeutic evidence. The majority
(94%) of the pharmacists’ recommendations were in accordance with the evidence-based
guides, as compared with the recommendations for which no evidence could be identified
(P < 0.001). Pharmacists reported that 98% of the patients had at least one problem with
use of their medication detected.
Conclusion The majority of the actions recommended by pharmacists during the medication
review process were consistent with the literature embedded in key Australian
information sources. Medication management in older people is complex and challenging,
as highlighted by the DRPs identified in 98% of our patients.Asuitably trained pharmacist,
with full access to the patient, medical record and supporting resources, can help to
improve the quality use of medicines in this at-risk population.
Evidence-based, drug-related problems, home medicines reviews