Medication review by pharmacists is proposed as part of the National Plan for the NHS¹. However, relatively little is known about the effectiveness of pharmacist-conducted medication review. Two randomised trials have shown that such review is effective in identifying pharmaceutical care issues^2,3. Inclusion criteria in such studies have varied e.g. including those on at least 3 or 6 repeat medicines. Some have included all patients; others only elderly people. It is unclear which factors (e.g. patient characteristics, medication or general practice care) makes people more or less likely to benefit from a medication review. Finite resources mean that we need this information to help target the intervention.

Method
We conducted a randomised controlled trial of elderly patients in 4 randomly selected general practices. Patients were eligible if aged 65 or over, took at least 1 repeat medicine and were not in a care home⁴. They were randomly allocated to a control group (normal care) or an active group (invited to a pharmacist-conducted clinical medication review clinic). This paper reports on the characteristics that made a pharmacist intervention, as a result of the review clinic, more likely.

Medication review consultations were held with 589 of the 608 people allocated to the active group. An intervention was defined as any one or more of the following recommendations: a medication change; a test (e.g. blood pressure); patient counselling or referral to the GP.

The variables analysed were: patient age (65-69,70-74 & 75+), sex, whether housebound, number of repeat medications (1, 2-4, 5-7, 8+), evidence of medication review in last 12 months.

Results
The pharmacist made an intervention in 333 (56%) of patients in the active group. Multiple logistic regression analysis showed that the making of an intervention by the pharmacist was predicted by the patients taking a greater number of medicines (p<0.004) and the patient's GP not having reviewed the medicines in the previous 12 months (p<0.01). Three other factors (patient age, sex, being housebound) were not predictive.

Discussion
Age, sex and requiring a home visit had no effect on need for pharmacist review. The chances of an intervention taking place increased with number of medicines and not having a review in the last 12 months. If resources are limited then patients on multiple medications and with no documented evidence of doctor review should be targeted for medication review. There may be no justification for having an age cut off, or providing only review for domiciliary patients.

References

1. Pharmacy in the future. Implementing the NHS Plan. Dept. of Health September 2000.
2. Granas AG, Bates I. The effect of pharmaceutical review of repeat prescriptions in general practice. Int J Pharm Pract 1999;7:264-75.
3. Mackie CA, Lawson DH, Campbell A, et al. A randomised controlled trial of medication review in patients receiving polypharmacy in general practice. Pharm J 1999;263:R7.
4. Zermansky A, Raynor D, Freemantle N, Vail A, Lowe C. Clinical medication review by pharmacist of patients on repeat prescriptions www.ncchta.org/execsumm/summ620.htm.