Medication reviews in the community: results of a randomized, controlled effectiveness trial

Abstract

Br J Clin PharmacolBritish Journal of Clinical Pharmacology DOI:10.1111DOI:10. /j.1365DOI:10. -2125DOI:10. .2004 AimsTo examine the effectiveness of a multidisciplinary service model delivering medication review to patients at risk of medication misadventure in the community. MethodsThe study was carried out in three Australian states; Queensland, New South Wales and Western Australia, and conducted as a randomized, controlled effectiveness trial with the general practitioner (GP) as the unit of randomization. In total, 92 GPs, 53 pharmacists and 400 patients enrolled in the study. The multidisciplinary service model consisted of GP education, patient home visits, pharmacist medication reviews, primary healthcare team conferences, GP implementation of action plans in consultation with patients, and follow-up surgery visits for monitoring. Effectiveness was assessed using the four clinical value compass domains of (i) functional status, (ii) clinical outcomes, (iii) satisfaction and (iv) costs. The domains of functional status (assessed by the health-related quality of life measure SF-36 subscales) and clinical outcomes (as assessed by adverse drug events (ADEs), number of GP visits, hospital services and severity of illness) were measured at baseline and endpoint. Satisfaction was measured by success in implementation and by participant satisfaction at endpoint, and costs (as assessed using medication and healthcare service costs, less intervention costs) were measured preintervention and during the trial. In addition, process evaluation was conducted for intervention patients, in which problems and recommendations from the medication reviews were described. ResultsThe model was successfully implemented with 92% of intervention GPs suggesting that the model had improved the care of participating patients, a view shared by 94% of pharmacists. In addition, positive trends in clinical outcomes (ADEs and severity of illness) and costs (an ongoing trend towards reduction in healthcare service costs) were evident, although the trial was limited to a 6-month intervention time. No differences between intervention and control groups were identified for the healthrelated quality of life domain. The cost-effectiveness ratio for the intervention based on cost savings, reduced adverse events and improved health outcomes was small. The most common problems identified in the medication reviews were potential adverse drug reactions, suboptimal monitoring and adherence/lack of concordance issues. In total, 54.4% of recommendations were enacted, and 23.9% were implemented precisely as recommended in the medication review. Follow-up evaluation showed that 70.9% of actions had a positive outcome, 15.7% no effect and 3.7% had a negative outcome. Medication reviews in the communityBr J Clin Pharmacol 58 :6 649 ConclusionsMost studies emphasize efficacy and the best achievable clinical outcomes rather than whether an intervention will be effective in practice. The current trial showed that three of the four domains in the clinical va...

Consumer perspectives of the Australian Home Medicines Review Program: Benefits and barriers

“…1 Source: http://www.medicareaustralia.gov.au/provider/pbs/fourth-agreement/hmr.jsp 2 Source: http://www.guild.org.au/mmr/content.asp?id=53 3 Patients who have had an HMR in the recent past 4 Patients who have never had an HMR but would qualify for this service according to the Australian Government's eligibility criteria and risk factors 5 This paper does not include the Aboriginal and Torres Strait Islander and ethnic consumer groups. Due to their distinctly different circumstances, the attitudes of these consumer segments are discussed in a separate paper.…”

“…[1][2][3][4][5][6][7] It is therefore in the public interest that this cognitive pharmacy service is effectively used by patients who are at highest risk of medication misadventure. However, recent research confirmed that those in greatest need of an HMR are the least likely to receive this service.…”

Time to Rethink the Funding Model for Home Medicines Review

“…MedsChecks, Diabetes MedsChecks and Clinical Interventions by pharmacists), none of which is supported by any evidence in the context of the Australian healthcare setting. Conversely, there is evidence on the value of HMRs to consumers, 2,5,6 a demonstration of cost savings of up to $550 per HMR to the health system, 7-10 and a demonstrable track record that clearly illustrates the delivery of a truly collaborative service between GPs, patients, independent accredited pharmacists and other community or hospitalbased pharmacists [11][12][13][14][15][16][17][18] (Fig. 1).…”

“…Australian studies have demonstrated that HMRs can resolve, manage or reduce medicine-related problems for a wide range of patients. [11][12][13][14][15][16][17][18][19][20][21] In addition, HMRs improve health outcomes; for example, in patients receiving betablockers for heart failure, an HMR resulted in a 45% reduction in likelihood of hospitalisation for heart failure at any time. 18 Another study found that an HMR in patients taking warfarin resulted in a 79% reduced likelihood of bleeding-associated hospitalisation 2-6 months after the HMR.…”

“…21 Research conducted across Australia has consistently demonstrated that HMRs are a cost-effective way to identify and resolve medicine-related problems and improve health outcomes. [11][12][13][14][15][16][17][18][19] Based on Australian data, [7][8][9][10][11][18][19][20] approximately 25 000 out of every 100 000 HMRs conducted are provided to patients with high-cost medical conditions (diabetes, heart failure and atrial fibrillation). Cost savings to the health system arising from HMRs for those 25 000 Australians can be estimated at approximately $550 per person for each HMR (from hospital costs and length of stay), totalling $13.75 million per year.…”