Impact of medication reviews on inappropriate prescribing in aged care

Abstract

Background: Inappropriate prescribing (IP) is prevalent among elderly people in aged care facilities. Little has been published on the effect of pharmacists performing residential medication management reviews (RMMRs) in aged care on the appropriateness of prescribing. RMMRs represents a key strategy for achieving quality use of medicines, by assisting residents in aged care facilities and their carers to better manage their medicines. However, the structure of RMMR has moved from annual to every two years for each resident.

Objectives: The primary objective of this study was to investigate the impact of pharmacists performing RMMRs on medication use appropriateness, as measured by the Medication Appropriateness Index (MAI).

Methods: Retrospective analysis of RMMRs pertaining to 223 aged care residents aged ≥65 years in Sydney, Australia. The MAI was applied on two RMMR cohorts; newer cohort (n = 111, 2015) i.e. following the recent changes to the RMMR funding and older cohort (n = 112, 2012) at baseline, after pharmacists’ recommendations (assuming all pharmacists’ recommendations were accepted by the General Practitioner [GP]), and after the actual uptake of pharmacists’ recommendations by the GP. Differences in inappropriate prescribing were measured using the Wilcoxon sign rank test.

Results: Overall, all patients in the study (n = 223) had at least one inappropriate rating at baseline (median MAI score of 26 for the old cohort and 27 for the newer cohort). The median cumulative MAI scores were significantly lower after the RMMRs by pharmacists (15.5 and 20 for the old and new cohort respectively, p < .001) and following the uptake of recommendations by the GP, indicating an increased appropriateness of drug regimen after the medication review (20 and 22 for the old and new cohort respectively, p < .001).

Conclusion: This study shows that pharmacist-led medication reviews are effective in reducing inappropriate prescribing among aged care residents, as demonstrated by the reduction in MAI scores. Future studies should focus on the impact of such a decrease on patient outcomes.

Keywords:

• Inappropriate prescribing
• medication reviews
• Medication Appropriateness Index
• older people
• elderly
• aged care
• pharmacists

Transparency

Declaration of funding

The authors received no specific funding or financial assistance for this work.

Author contributions: This study was designed and planned by L.G.K., R.C., G.P., T.S.Z.; L.G.K. was responsible for data collection and writing the manuscript; R.C. and L.G.K. evaluated the potentially inappropriate prescribing in the data and undertook statistical analysis; all authors assisted in the preparation of the manuscript. P.J.H. was the provider of the RMMRs used to conduct this study.

Declaration of financial/other relationships

P.J.H. has disclosed that he is contracted as a consultant pharmacist advisor to Meditrax who supplied the de-identified data. L.G.K., T.S.Z., G.P., P.N. and R.C. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

No assistance in the preparation of this article is to be declared.