Comprehensive medication reviews for elderly patients: Findings and recommendations to physicians

Objectives: To assess drug-related problems (DRPs) documented by specially trained community pharmacists during the Finnish comprehensive medication review (CMR) procedure and to describe the resulting interventions for home-dwelling and assisted-living primary care patients 65 years or older. Methods: Retrospective analysis of applicable written CMR case reports for primary care patients 65 years or older by 26 community pharmacists attending a 1.5-year CMR accreditation training (174 patients recruited; 121 included in the analysis). The main outcome measures were DRPs and physicians' acceptance of pharmacists' recommendations. Results: The pharmacists reported a total of 785 DRPs (average of 6.5/patient). DRPs were more common among home-dwelling patients (7.2) than those in the assisted-living setting (5.5; P = 0.014) but were similar in nature. Inappropriate drug choices were the most common DRPs (17% of DRPs), involving most often hypnotics and sedatives. Also, indications with no treatment were common (16%), particularly those associated with cardiovascular diseases and osteoporosis. Pharmacists made 649 recommendations, 55% (n = 360) of which were accepted by physicians without revision. In 51% of DRPs (n = 403), CMRs resulted in change of drug therapy; stopping a drug was the most common change. Conclusion: Specially trained pharmacists were able to identify DRPs among elderly primary care patients by using a CMR procedure, and more than one-half of the identified DRPs led to medication changes. The pharmacists' special knowledge of geriatric pharmacotherapy and access to clinical patient data were crucial for recognizing DRPs.