A pre–post study of pharmacist-led medication reviews within a hospital-based residential aged care support service

Abstract Background Hospital-based residential aged-care support service teams typically consist of doctors and nurses who provide hospital substitutive care to aged-care residents. There is limited literature evaluating the pharmacist’s role in such aged-care support teams. Objective To analyse the effect of residential aged-care support service pharmacist-led medication reviews on polypharmacy, drug burden index, potentially inappropriate medications, and potential prescribing omissions for aged-care residents. Methods Residents referred to a residential aged-care support service pharmacist for medication review over a 12-month period were included. The pharmacist communicated medication-related problems and recommendations to the resident’s general practitioner and residential aged-care support service medical practitioner. Residents’ medication histories were obtained at baseline and one-month postintervention. The number of medications and their associated drug burden indices were compared using paired t-tests; potentially inappropriate medications and potential prescribing omissions were compared using Wilcoxon’s signed rank test. Key findings Of 175 residents (mean age 84 years) referred for pharmacist-led medication review, 146 had postintervention evaluation after one-month (median 29 days). Mean number of medications reduced from 12.47 at baseline to 11.84 postintervention (mean difference (95% CI): 0.63(0.33–0.93), P .001). Mean drug burden index score reduced from 1.54 at baseline to 1.37 postintervention (mean difference (95% CI): 0.17(0.10–0.24), P .001). More residents experienced a decrease in inappropriate medications (median (IQR) pre: 2(1–3), post: 1(0–2), P .001) and prescribing omissions (median (IQR) pre: 0(0–1), post: 0(0–0), P = .003) compared with those that had an increase. Conclusions Medication reviews performed by pharmacists embedded in hospital-based residential aged-care support services may improve medication prescribing. Further research into such preventative health service models is required.