GP acceptance of pharmacist advice up to 84%

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A systematic review has found medication reviews identified up to four problems per patient, with generally high acceptance of pharmacist recommendations

Collaborative medication reviews are successful at identifying and resolving medication-related problems, Australian pharmacist researchers have found.

However there is minimal published evidence on clinical or resident-centred outcomes such as falls, hospitalisations or quality of life.

A systematic review published in the Australasian Journal on Ageing looked at 13 studies that investigated medication reviews, eight of which studied Residential Medication Management Reviews (RMMRs).

All medication reviews included in the analysis were performed in Australian residential aged care facilities, with pharmacists leading them in 11 studies, geriatricians in one study, and a GP in one study.

Five studies revealed that medication reviews identified an average of 2.7-3.9 medication-related problems per resident.

In four pooled studies, the most commonly reported medication-related problems were undertreated conditions (23%)—for example, untreated conditions, missing preventative treatments—and drug selection problems (22%)—for example, duplication, drug interactions, wrong dose, strength, or form, missing indications, contraindications present.

In eight studies that reported types of recommendations identified during medication reviews, a change in or new clinical or laboratory monitoring was the most common recommendation (27%).

Adding a medication comprised just 6% of recommendations.

The mean number of review recommendations per resident was between 1.9 and 4.0.

Pooled results of four studies showed that 45% to 84% of medication review recommendations were accepted by GPs.

Recommendations that did not involve changes in therapies had a higher acceptance rate than those that did.

Lead author Esa Chen, from the Centre for Medicine Use and Safety at Monash University, said the results show collaborative medication reviews are successful at identifying and resolving medication-related problems for aged care residents.

“This is important because the Aged Care Quality and Safety Commission has reported that concerns about medication management is the leading reason for complaints they receive,” she told AJP.

“We found that RMMRs identified up to four medication-related problems identified per review.

“Currently it’s estimated that only 38% of residents receive a review annually,” she said.

The study pointed out that RMMRs have been capped so that most residents are eligible for one every two years.

“We need to invest in research into the possible clinical outcomes,” Ms Chen said.

The generally high GP acceptance rate of recommendations “shows the benefit of GPs and pharmacists working together to improve medication use,” she added.

“It’s likely that acceptance of pharmacists’ recommendations is higher when pharmacists have access to clinical information and are familiar with each resident’s goal of care.

“Implementation of recommendations may be enhanced when post-review monitoring and follow-up is further incentivised.”

See the full review here

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