AIMSThe 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. METHODSThis 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. RESULTSOne 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]. CONCLUSIONMRF 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. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Medication-related hospital admissions are a significant problem in aged polypharmacy patients.• The evidence of the impact of professional pharmacy services on hospital admissions remains uncertain. WHAT THIS STUDY ADDS• The percentage of medication-related hospital admissions was significantly lower in patients receiving medication review with follow-up (26.2% vs. 73.8%, P < 0.05).• The probability of being hospitalized was 3.7 times higher in the comparison group (CG) than in the intervention group (IG) (P < 0.05).• Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 vs. CG: €301; P = 0.018].

The aim of this study was to design and test a pressure ulcer severity score based on assessment by experienced clinicians. Fifty pressure ulcers were each evaluated independently by seven experienced clinicians, using a scale that ranged from 0 (mildest damage) to 10 (most severe). Ulcer characteristics were analysed to determine which factors related to the assessments. A second set of 50 ulcers was used to test the validity of the resulting scoring system. Inter- and intra-observer reliability were tested in a further 10 pressure ulcers. A multivariate linear model was produced, based on the following three variables: colour (CO-matched-matched) in the wound base; depth (DE)?of the ulcer; and mean diameter (D)?of the wound (‘CODED’). The coefficients for each variable were rounded to yield points in an additive equation, the CODED score. This score had a high correlation (r = 0.92, P<0.001) with the second set of evaluations, used to test the score performance. The CODED score is a simple and valid tool to quantify the progress of a pressure ulcer. It has a high correlation with the severity assessment of experienced clinicians and is reliable when used by non-experienced observers.

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