The Pharmacist??s Role in Rational Drug Therapy of the Aged

Adamcik, Barbara A.; Rhodes, Richard S.

doi:10.2165/00002512-199303060-00002

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…The involvement of pharmacists in the care of older patients with polypharmacy is one of the most commonly described measures to optimize prescribing and reduce DRP [3, 10]. In the UK the National Service Framework for Older People recommends to regularly conduct medication reviews accompanied by paid medicine management services [11].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of a clinical medication review in vulnerable older patients at hospital discharge, a randomized controlled trial

Heijden

Bruijne²,

Nijpels

et al. 2019

Int J Clin Pharm

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Background Drug-related problems (DRP) following hospital discharge may cause morbidity, mortality and hospital re-admissions. It is unclear whether a clinical medication review (CMR) and counseling at discharge is a cost-effective method to reduce DRP. Objective To assess the effect of a CMR on health care utilization and to investigate whether CMR is a cost-effective method to reduce DRP in older polypharmacy patients discharged from hospital. Setting 24 community pharmacies in the Netherlands. Method A cluster-randomized controlled trial with an economic evaluation. Community pharmacies were randomized to those providing a CMR, counseling and follow-up at discharge and those providing usual care. Main outcome measures Change in the number of DRP after 1 year of follow-up and costs of health care utilization during follow-up. In 216 patients the use of health care was prospectively assessed. Missing data on effects and costs were imputed using multiple imputation techniques. Bootstrapping techniques were used to estimate the uncertainty around the differences in costs and incremental cost-effectiveness ratios. Results CMR resulted in a small reduction of DRP. The proportion of patients readmitted to the hospital during 6 months of follow-up was significantly higher in the intervention group than in the control group (46.4 vs. 20.9%; p < 0.05). Health care costs were higher in the intervention group, although not statistically significant. The costs of reducing one DRP by a CMR amounted to €8270. Conclusion A CMR in vulnerable older patients at hospital discharge led to a small reduction in DRP. Because of a significantly higher use of health care and higher number of re-hospitalisations post CMR, the present study data indicate that performing the intervention in this patient population is not cost-effective.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of a clinical medication review in vulnerable older patients at hospital discharge, a randomized controlled trial

Heijden

Bruijne²,

Nijpels

et al. 2019

Int J Clin Pharm

View full text Add to dashboard Cite

show abstract

Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?

Hanlon

Lindblad

Gray

2004

The American Journal of Geriatric Pharmacotherapy

116

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When Drug Treatment in the Elderly Is Not Cost Effective

Chadwick

Levitt

1995

Drugs & Aging

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In light of moves towards the view that rationing of healthcare resources is inevitable, the question arises as to whether age is a relevant consideration. To hold age as relevant in this context attracts the charge of agism; however, age may be related to some other characteristic(s) that are pertinent. In the context of drug treatment of the elderly, there is evidence to suggest that there are important differences between older and younger patients in terms of adverse responses to drugs because of factors such as physiological changes and multiple health problems, which occur with aging. On the other hand, some studies show beneficial effects of drug therapy. There is a need for more empirical data on cost effectiveness. Ethics arguably have to take into account factors other than cost effectiveness, such as equity. A central question is whether what is required is a set of criteria in addition to cost effectiveness, or an interpretation of cost effectiveness sensitive to broader considerations, such as quality of life (QOL). In relation to the latter, the issue of age-specific measurements of QOL remains problematic.

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The Pharmacist??s Role in Rational Drug Therapy of the Aged

Cited by 3 publications

References 19 publications

Cost-effectiveness of a clinical medication review in vulnerable older patients at hospital discharge, a randomized controlled trial

Cost-effectiveness of a clinical medication review in vulnerable older patients at hospital discharge, a randomized controlled trial

Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?

When Drug Treatment in the Elderly Is Not Cost Effective

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