Background Home-dwelling patients have many kinds of symptoms that may be related to their medications and poor coordination of their drug therapy management. In Kirkkonummi municipality, about 84% of home-dwelling patients use multiple medicines (>6 medicines) which pose a risk for inappropriate medication, medication-related problems and additional costs.
Purpose Our objective was to identify those home-dwelling patients who would benefit from pharmacist-conducted medication reviews. The goal of this community-based project was to improve patients’ quality of life and reduce medication-related problems, and thus, support coping at home as long as possible. The procedure is expected to reduce costs: a pharmacist-conducted medication review costs approx. 40€ compared to an inpatient treatment period costing approx. 4,000€. Also reduction of the use of Health Centre’s emergency room and hospital is expected. Furthermore, the project facilitates implementation of collaborative practices in mediation management at the Health Centre.
Material and methods Home care nurses identified patients with established criteria. The medication risk assessment was intended to be made to all home care patients and the report to be reviewed by the clinical pharmacist. The physician could then make the required changes in the medication. The medication review was preferred to take place prior to the patient’s annual control visit with the physician. The patient must meet one of the following criteria in order to have the medication risk-assessment, followed by the pharmacist-conducted medication review:
A health care professional (physician or nurse) is concerned about the patient’s medication or suspects a medication-related problem
The patient has particular treatment-induced adverse drug reactions, such as constipation, dry mouth, urinary retention, dizziness, falls, confusion, sweating, restlessness or daytime sleepiness
The patient’s GFR is less than 60 ml/min/1.73 m2
The patient has orthostatic hypotension.
The medication review will use the nurse-conducted medication risk assessment, patient’s medication list, laboratory test results, and it includes review of the following aspects:
medication dosing, timely administration, duplication of medication
anticholinergic medication, serotonergic, orthostatic and sedative burden
potentially inappropriate medicines in the elderly (elderly medication database by Finnish Medicines Agency)
medication-related laboratory tests
renal function and its effect on the medication
possible connexion of patient’s symptoms to medication
problems in administering the medication and potential alternative formulations
medication without indication
diagnosis without necessary medication
Results Medication changes were made to 90% of the reviewed patients (n = 31). The emphasis was on interactions and renal function, thus the amount of medicines and/or their doses were reduced.
Conclusion Physicians have received well the new collaborative medication review service. Home care nurses will also learn to identify medication-related problems and use medication review tools. Patients, however, are often attached to their medicines and making changes can be challenging. The need for this kind of collaborative medication review service is obvious and it will be further developed to meet the local needs.
References and/or acknowledgements No conflict of interest.
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