Retrospective Evaluation of Home Medicines Review by Pharmacists in Older Australian Patients Using the Medication Appropriateness Index

Abstract

Background: Home Medicines Review (HMR), a community-based collaborative service provided by general practitioners (GPs) and accredited pharmacists in Australia, has demonstrated effectiveness in preventing, detecting, and resolving medication-related problems. The Medication Appropriateness Index (MAI) has been found to be a reliable, valid, standardized instrument for assessment of multiple elements of drug therapy prescribing. Objective: To retrospectively evaluate the impact of HMRs on the appropriateness of prescribing, using the MAI as a tool to categorize pharmacists' recommendations. Methods: A retrospective analysis was performed on a sample of 270 HMR cases pertaining to community-dwelling older people (≥65 years) in New South Wales, Australia. The HMRs were collected from 7 accredited pharmacists using purposive sampling. All HMRs were conducted between February 2006 and October 2009. MAI scores were retrospectively calculated at baseline, after the HMR service based on the pharmacist's recommendations to the GP, and following uptake of the pharmacist's recommendations by the GP. Results: The mean ± SD age of the patients was 75.3 ± 7.4 years and 55% were female. Overall, almost all (99%; n = 267) patients had at least 1 inappropriate rating at baseline and more than 50% (n = 154) of the patients had a cumulative MAI score >15. The mean MAI score at baseline was 18.6 ± 11.3, which decreased to 9.3 ± 7.5 after HMR. The number of patients with a cumulative MAI score ≥15 increased to 216 after the HMR service, compared to 116 at baseline. Pharmacists' recommendations documented in the HMR reports and uptake of these recommendations by the GP resulted in a statistically significant decrease in the MAI scores (both p < 0.001). Conclusions: The study demonstrates that the provision of medication reviews by accredited pharmacists can improve the appropriateness of prescribing as demonstrated by the change in MAI score and, hence, has the potential to improve patient outcomes. Pharmacists who perform medication reviews could also consider including the systematic approach of applying the MAI to assist in optimizing prescribing in older people.