General Practitioner Acceptance of Medication Review in Sydney Nursing Homes

Objectives: To conduct a one‐off medication review in nursing homes, ascertain the medication problems and determine why recommendations made by the pharmacist conducting the review were not implemented by general practitioners. Setting: Fourteen nursing homes in the Northern Sydney area that did not already have a pharmacist reviewing medication charts agreed to participate. Method: Twenty‐one general practitioners were recruited, each with at least eight residents in the participating nursing homes. The medication charts of 202 residents were reviewed once by an independent, accredited pharmacist, who then discussed potential problems with the resident's general practitioner. The number of changes, and reasons for changes to drug therapy were detailed from the time of notification of the review to the time the review was undertaken (six weeks), and also at the six‐week follow‐up. For the latter period, changes recommended by the reviewer were distinguished from those made by the general practitioner independently of the pharmacist. A comparison of community pharmacy and nursing home records was also undertaken. Results: General practitioners made 148 changes to drug therapy in 60 of the 202 residents in the six‐week period between notification and commencement of the review. Clinical reasons were evident for almost all these changes. The mean numbers of regular and ‘as required’ medications per resident on the day of the review were 3.9 and 1.5 respectively. A median reduction of 0.5 doses of regular medication per resident was observed (P > 0.001). The reviewing pharmacist made 280 recommendations and 141 (50%) of these were accepted by the general practitioners. Pathology tests and clinical signs assessments (e.g. blood pressure measurement) were recommended by the pharmacist on 129 occasions, but only 44 (34%) of these were accepted by the general practitioners. Changes to therapy occurred in 69 residents. Only 21% of the medication records in the nursing home were identical to the community pharmacy medication records. Conclusion: General practitioners were often reluctant to change drug therapy or respond to the pharmacist's recommendation for ordering blood tests when residents were clinically stable. Government pressure on the medical profession to reduce ‘over‐servicing’ and doctors reluctance to implement an intervention that could upset the ‘status quo’ in a frail elderly resident, presented dilemmas for the pharmacist in the quest for high quality prescribing.