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A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients

From the Departments of Family Medicine (J. Sellors, Kaczorowski, C. Sellors, Dolovich, Cosby, Howard, Hardcastle) and Clinical Epidemiology and Biostatistics (J. Sellors, Kaczorowski, Woodward, Willan, Goeree, Trim, Sebaldt) and the Centre for Health Economics and Policy Analysis (Woodward), McMaster University, Hamilton, Ont.; the Centre for Evaluation of Medicines, St. Joseph's Hospital, Hamilton, Ont. (J. Sellors, Kaczorowski, C. Sellors, Dolovich, Willan, Goeree, Sebaldt); the Faculty of Pharmacy, University of Toronto, Toronto, Ont. (Dolovich); and the Canadian Pharmacists Association, Ottawa, Ont. (Poston).

Correspondence to: Dr. Janusz Kaczorowski, Department of Family Medicine, McMaster University, 1200 Main St. West, HSC-2V11, Hamilton ON L8N 3Z5; fax 905-521-5594; kaczorow{at}mcmaster.ca

Background: Pharmacists can improve patient outcomes in institutional and pharmacy settings, but little is known about their effectiveness as consultants to primary care physicians. We examined whether an intervention by a specially trained pharmacist could reduce the number of daily medication units taken by elderly patients, as well as costs and health care use.

Methods: We conducted a randomized controlled trial in family practices in 24 sites in Ontario. We randomly allocated 48 randomly selected family physicians (69.6% participation rate) to the intervention or the control arm, along with 889 (69.5% participation rate) of their randomly selected community-dwelling, elderly patients who were taking 5 or more medications daily. In the intervention group, pharmacists conducted face-to-face medication reviews with the patients and then gave written recommendations to the physicians to resolve any drug-related problems. Process outcomes included the number of drug-related problems identified among the senior citizens in the intervention arm and the proportion of recommendations implemented by the physicians.

Results: After 5 months, seniors in the intervention and control groups were taking a mean of 12.4 and 12.2 medication units per day respectively (p = 0.50). There were no statistically significant differences in health care use or costs between groups. A mean of 2.5 drug-related problems per senior was identified in the intervention arm. Physicians implemented or attempted to implement 72.3% (790/1093) of the recommendations.

Interpretation: The intervention did not have a significant effect on patient outcomes. However, physicians were receptive to the recommendations to resolve drug-related problems, suggesting that collaboration between physicians and pharmacists is feasible.

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