Quality Use of the Pathology Data in Home Medicines Reviews: A Retrospective Evaluation

Background: Laboratory tests can be important tools for the assessment of pharmacotherapy. Nonetheless, there are no previous studies that have explicitly focused on the role of pathology data in Home Medicines Reviews (HMR), an Australian medication review program. Objective: Evaluate pharmacists' recommendations regarding laboratory testing in the medication review process. Methods: This retrospective review of HMRs assessed the prevalence of the pathology data provided by general practitioners. Additionally, the pharmacists' recommendations based on these laboratory data were compared with national and international guidelines. Results: In total, 580 reports were evaluated. Of these, 179 reports did not contain any pathology data. Pharmacists commented on provided laboratory values in 324 reports and recommended further testing in 473 reports. Not all suggestions were related to previous values or were in line with guidelines. Most recommendations were regarding vitamin D and lipids (69% and 62% of medication review reports, respectively). Particularly, regarding renal impairment, pharmacists used their knowledge on dose adjustments and contraindications. In relation to full blood count, vitamin B12, and thyroid function, unjustified screenings were often recommended. In 26% of all reports, the pharmacists requested an array of tests without explaining the necessity for these tests. Conclusion and Relevance: Pharmacists provided useful advice based on the pathology data, which was concordant with national and international guidelines; however, in some cases, there was no rationale for the test recommendations provided. The outcome of the HMR program might be further enhanced if pharmacists had direct access to the patients' pathology data.