Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial
Fuente:
Redalyc
Saved in:
| Main Author: | |
|---|---|
| Format: | Artículo científico |
| Language: | en |
| Published: |
Centro de investigaciones y Publicaciones Farmacéuticas
2020
|
| Subjects: | |
| Online Access: | |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1876471088983048192 |
|---|---|
| author | Raquel Varas-Doval |
| author_facet | Raquel Varas-Doval |
| contents | Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial Raquel Varas-Doval Miguel A. Gastelurrutia Shalom I. Benrimoj Victoria García-Cárdenas Loreto Sáez-Benito Fernando Martinez-Martínez Medicina Spain Pharmacies Pharmacists Polypharmacy Community Pharmacy Services Background: Medication review with follow-up (MRF) is a service where community pharmacists undertake a medication review with monthly follow-up to provide continuing care. The ConSIGUE Program assessed the impact and implementation of MRF for aged polypharmacy patients in Spanish Community Pharmacies. The present paper reports on the clinical impact evaluation phase of ConSIGUE.Objective: The main objective of the study was to measure the effect of MRF on the primary outcome of the number of uncontrolled health problems. Secondary objectives were to analyze the drug-related problems (DRPs) identified as potential causes of ineffective or unsafe medications and the pharmacists’ interventions implemented during MRF provision.Methods: An open-label multi-centered cluster randomized study with comparison group (CG) was carried out in community pharmacies from 4 provinces in Spain during 6 months. The main inclusion criteria were patients over 64 years old, using 5 or more medicines. The intervention group (IG) received the MRF service (advanced medication review-type 3 MR) whereas patients in the CG received usual care.Results: 178 pharmacies recruited 1403 patients (IG= 688 patients; CG= 715 patients). During the 6 months of the study 72 patients were lost to follow up. The adjusted multi-level random effects models showed a significant reduction in the number of uncontrolled health problems over the periods in the IG (-0.72, 95% CI: -0.80, -0.65) and no change in the CG (-0.03, 95% CI: -0.10, 0.04). Main DRPs identified as potential causes of failures of uncontrolled health problems’ treatment were undertreated condition (559 DRPs; 35.81%), lack of treatment adherence (261 DRP; 16.67%) and risk of adverse effects (207 DRPs; 13.53%). Interventions performed by pharmacist to solve DRP mainly included the addition (246 interventions; 14.67%) and change (330 interventions; 19.68%) of a medicine and educational interventions on medicine adherence (231 interventions; 13.78%) and non-pharmacological interventions (369 interventions; 22.01%).Conclusions: This study provides evidence of the impact of community pharmacist on clinical outcomes for aged patients. It suggests that the provision of an MRF in collaboration with general medical practitioners and patients 2020 artículo científico 1885-642X https://www.redalyc.org/articulo.oa?id=69065617014 https://www.redalyc.org/journal/690/69065617014/ https://www.redalyc.org/journal/690/69065617014/html/ https://www.redalyc.org/journal/690/69065617014/69065617014.epub https://www.redalyc.org/journal/690/69065617014/movil 10.18549/PharmPract.2020.4.2133 en http://www.redalyc.org/revista.oa?id=690 Pharmacy Practice application/pdf Centro de investigaciones y Publicaciones Farmacéuticas Pharmacy Practice (España) Num.4 Vol.18 |
| format | Artículo científico |
| id | redalyc_69065617014 |
| institution | Redalyc |
| language | en |
| publishDate | 2020 |
| publisher | Centro de investigaciones y Publicaciones Farmacéuticas |
| spellingShingle | Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial Raquel Varas-Doval Medicina Spain Pharmacies Pharmacists Polypharmacy Community Pharmacy Services Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial Raquel Varas-Doval Miguel A. Gastelurrutia Shalom I. Benrimoj Victoria García-Cárdenas Loreto Sáez-Benito Fernando Martinez-Martínez Medicina Spain Pharmacies Pharmacists Polypharmacy Community Pharmacy Services Background: Medication review with follow-up (MRF) is a service where community pharmacists undertake a medication review with monthly follow-up to provide continuing care. The ConSIGUE Program assessed the impact and implementation of MRF for aged polypharmacy patients in Spanish Community Pharmacies. The present paper reports on the clinical impact evaluation phase of ConSIGUE.Objective: The main objective of the study was to measure the effect of MRF on the primary outcome of the number of uncontrolled health problems. Secondary objectives were to analyze the drug-related problems (DRPs) identified as potential causes of ineffective or unsafe medications and the pharmacists’ interventions implemented during MRF provision.Methods: An open-label multi-centered cluster randomized study with comparison group (CG) was carried out in community pharmacies from 4 provinces in Spain during 6 months. The main inclusion criteria were patients over 64 years old, using 5 or more medicines. The intervention group (IG) received the MRF service (advanced medication review-type 3 MR) whereas patients in the CG received usual care.Results: 178 pharmacies recruited 1403 patients (IG= 688 patients; CG= 715 patients). During the 6 months of the study 72 patients were lost to follow up. The adjusted multi-level random effects models showed a significant reduction in the number of uncontrolled health problems over the periods in the IG (-0.72, 95% CI: -0.80, -0.65) and no change in the CG (-0.03, 95% CI: -0.10, 0.04). Main DRPs identified as potential causes of failures of uncontrolled health problems’ treatment were undertreated condition (559 DRPs; 35.81%), lack of treatment adherence (261 DRP; 16.67%) and risk of adverse effects (207 DRPs; 13.53%). Interventions performed by pharmacist to solve DRP mainly included the addition (246 interventions; 14.67%) and change (330 interventions; 19.68%) of a medicine and educational interventions on medicine adherence (231 interventions; 13.78%) and non-pharmacological interventions (369 interventions; 22.01%).Conclusions: This study provides evidence of the impact of community pharmacist on clinical outcomes for aged patients. It suggests that the provision of an MRF in collaboration with general medical practitioners and patients 2020 artículo científico 1885-642X https://www.redalyc.org/articulo.oa?id=69065617014 https://www.redalyc.org/journal/690/69065617014/ https://www.redalyc.org/journal/690/69065617014/html/ https://www.redalyc.org/journal/690/69065617014/69065617014.epub https://www.redalyc.org/journal/690/69065617014/movil 10.18549/PharmPract.2020.4.2133 en http://www.redalyc.org/revista.oa?id=690 Pharmacy Practice application/pdf Centro de investigaciones y Publicaciones Farmacéuticas Pharmacy Practice (España) Num.4 Vol.18 |
| title | Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial |
| topic | Medicina Spain Pharmacies Pharmacists Polypharmacy Community Pharmacy Services |
| url | https://www.redalyc.org/articulo.oa?id=69065617014 https://www.redalyc.org/journal/690/69065617014/ https://www.redalyc.org/journal/690/69065617014/html/ https://www.redalyc.org/journal/690/69065617014/69065617014.epub https://www.redalyc.org/journal/690/69065617014/movil |