Pharmacist-led medication review for knee pain in older adults: content, process and outcomes

Objective To describe the content and evaluate the effects of pharmacist-conducted medication review delivered in the context of a randomised controlled trial. The intervention aimed to optimise the pharmacological management of knee pain in older adults by negotiating an individualised treatment plan with patients. Method A structured medicines review was conducted by a pharmacist in the general practice setting for patients aged over 55 years with knee pain in a randomised controlled trial. According to patients' needs they could receive three to six consultations of approximately 20 minutes' duration over a 10 week period. During reviews the patients' use of prescribed and over-the-counter medicines was explored and perceived effectiveness in pain control was discussed. The pharmacist made treatment recommendations based on an algorithm previously agreed with the participating general practitioners. The pharmacist also provided education and advice on medicines and relevant lifestyle aspects. Patients in the comparison group received a control intervention (information leaflet and telephone call). Key findings One hundred and eight patients from 13 general medical practices were randomised to the enhanced pharmacy review group and 106 attended. Knee-pain scores showed significant improvement at 3 but not 12 months compared with the control intervention. The pharmacist made treatment recommendations for all patients and provided advice and education to over 90%. For eight out of 10 patients the treatment recommendation was for changes to treatment. Of the 36 patients for whom a non-steroidal anti-inflammatory drug was being prescribed at baseline the pharmacist recommended discontinuation in 17 cases and change to intermittent use in three cases. The mean amount of time spent per patient was around 60 minutes in three sessions. Conclusion Pharmacist-conducted medicines review identified substantial opportunities to improve pharmacological treatment for knee pain, and to reduce side effects from analgesic medicines. The findings of this study suggest that pharmacists can make a positive contribution to the management of patients with knee pain in primary care in the short-term. These findings support the wider implementation of pharmacist-led medicines review for patients with knee pain.