Impact of medication regimen reviews performed by community pharmacists for ambulatory patients through liaison with general medical practitioners

Abstract Objective To evaluate the cost and clinical benefits of the provision of medication regimen reviews (MRRs) by community pharmacists for patients identified and referred by a general practitioner using a collaborative approach. Method There were two cohorts of patients — 105 in stage 1 and 170 in stage 2 — from 34 GPs. The reviews were performed by 45 community pharmacists who had completed a training programme in MRR. The protocol was as follows: (1) a proforma MRR request form, including relevant clinical information and the patient's current regimen, was completed by the GP, (2) the review was conducted by the pharmacist and documented in a proforma report, (3) pharmacists and GPs met to discuss the review findings and recommendations for each patient, and (4) three months later, GPs were surveyed to verify any accepted recommendations and changes to medication regimen. A clinical panel estimated the clinical significance of the regimen changes for a subset of 141 cases. Key findings The patients had an average of five diagnoses, with cardiovascular disease (34 per cent) and musculoskeletal disease (15 per cent) the most common conditions. A total of 2, 220 medications were prescribed, representing a mean of eight per patient. In all, 869 changes to therapy were observed at the three-month follow up: 47 per cent drug ceased; 17 per cent dose reduced; 11 per cent dose increased; and 12 per cent drug changed. Examining the impact of MRR on the mean number of medications per patient, the null hypothesis of no difference pre- and post-MRR was rejected. There was a mean reduction of one medication per patient (P0. 001). As a consequence of this reduction, the average annual cost of medications was reduced by A240 per patient. This translated to a projected annual cost saving for medication alone of A90 per patient after offsetting the A150 cost (professional remuneration) of the MRR. Considering health outcomes, overall, the reviewers rated at least 40 per cent of the MRR changes as leading to a positive effect on the patient's health. Conclusion This study provides a good indication that MRR through GP-pharmacist collaboration in the community can lead to positive clinical benefits and reduction in health care costs.