Meds reviews impact limited, study finds


pharmacist with patient explaining medicines

A new Canadian study has found that medication reviews conducted by pharmacists did not significantly modify prescription drug use

But comparing this to the Australian model is like “comparing an egg with a soufflé,” one Twitter commentator pointed out.

The study, which collected data on community pharmacist-led medication reviews via British Columbia’s population-based PharmaNet drug utilisation system, sparked debate on Twitter including from Dr Evan Ackermann, who has been vocal about community pharmacy on the platform.

Researchers studied the impact of first medication reviews conducted between May 2012 and June 2013, using interrupted time series analysis to assess longitudinal changes in 147,770 patients receiving a standard review and a more intensive pharmacist consultation (16,006 patients).

“Our outcomes included drug utilisation, costs, potentially inappropriate prescriptions, and medication persistence measured through the proportion of commonly used chronic medications that were eventually refilled,” the authors wrote.

“Overall, we observed few changes in the level or trend of any of the outcomes we studied. Both review types were followed by significant increases in both the number of prescriptions per month and expenditures.

“The continuation of long-term medications did not change for three of four classes, and increased very slightly for the final class. We found no evidence of deprescribing, either for classes that are potentially problematic for long-term use (benzodiazepines and proton pump inhibitors) or for potentially inappropriate prescriptions in seniors.

“Our results suggest that medication reviews did not significantly modify prescription drug use by recipients.

“Future iterations of such programs might be modified to be better targeted and to encourage closer collaboration between pharmacists and prescribing health care professionals.”

Rural GP and Deputy Chairman of the RACGP National Quality Committee Dr Evan Ackermann highlighted the study’s findings…

…but CR&C (Campbell Research) was quick to ask how these interventions compared to Australian practice.

Dr Ackermann admitted that being pharmacist-only, the findings were “less comparable”.

Meanwhile, Rohan Elliott said that given the nature of the interventions, their limited impact was not surprising.

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7 Comments

  1. Big pharma
    14/09/2016

    Pharmacist-led medication reviews (medscheks) conducted in the pharmacy without collaboration showed no benefit or increased polypharmacy/sales…..big surprise!

    Maybe…just maybe a review independent of the supply pharmacy conducted in collaboration with the prescriber may be the answer? Stick that in your King review.

    • Andrew
      15/09/2016

      Yes, I’m confused….

      Isn’t this at least the fourth such article showing poor benefit from reviews done in community pharmacies?

      If the evidence is so unambiguous why are pilots and funding still being set up for the MedsCheck programs et.al? And such a large chunk of the 6CPA pool? It’s a serious question……

      • Drugby
        15/09/2016

        And deserves a serious answer…..

      • Karalyn Huxhagen
        15/09/2016

        agreed that the ‘in store’ reviews have not shown good benefit and there are more to come in the 6CPA in the trials program. The continual bias to pharmacy led reviews within phcy is not forgivable for those of us delivering the medications review services that do have research to back them. The King review is an opportunity to ask the questions of why these programs continue

      • Amy Page
        26/09/2016

        And the evidence for independent pharmacist reviews continues to contrast to the evidence for the collaborative GP-pharmacist review.

  2. pagophilus
    15/09/2016

    We have to remember bias in research. You can read a lot of articles and studies in the JPPR written and conducted by pharmacists which show great benefit of medication reviews. Let’s have non-pharmacists conduct these studies and see what the results are. Pharmacy is on a quest to increase funding sources and job opportunities. This, consciously or unconsciously, can lead to getting the results you want to see.

  3. max
    15/09/2016

    The reviews would result in change, if the pharmacists were given power to change the patient’s medication based on the review. The doctors mostly bin the reviews without acting on them, cos the docs want to make the point that only doctors call the shots. Pity really – the pharmacists could help the patients more if pharmacists had prescribing powers. And the above anti-review, anti-pharmacist comment by the biased Dr Ackermann, is yet another example of him confusing cause and effect. QED.

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