Impact of a pharmaceutical care model for non‐institutionalised elderly: results of a randomised, controlled trial

Objectives — To measure the impact of a community‐based geriatric pharmaceutical care model on specific process measures. Methods — The model was evaluated using a prospective, randomised, controlled study design. Clients who self‐presented or were referred by Home Care were eligible if they were 65 years of age or older, non‐institutionalised, taking two or more prescribed or non‐prescribed medications, and willing to provide signed informed consent. A pharmacist conducted a comprehensive drug therapy review on test clients, then addressed issues with the client and/or the client's physician, with follow‐up as required. Measurements included number of drugs, drug knowledge, adherence to therapy, cost of prescribed medicines, and number of reported symptoms obtained from a home medication history conducted by trained volunteers, the provincial prescription claims database, and response to a physician survey. Setting — The pharmaceutical care model was situated within a community‐based interdisciplinary health clinic targeting non‐institutionalised elderly. Key findings — One hundred and thirty‐five clients were randomised to test (n=69) or control (n=66). A mean of 14.4 (SD 4.6) potential or actual issues were identified in test clients. Ninety‐four per cent of physicians agreed with at least one of the pharmacist's recommendations but only 230 of 794 recommendations by the pharmacist (29 per cent) resulted in a change. There was no difference in overall number of prescribed or over‐the‐counter medications, drug costs, symptoms reported, drug knowledge or medication adherence between test and control groups post‐intervention. Future research — Further research is needed to identify barriers to changing drug use behaviour and facilitating acceptance of pharmaceutical care in the community.