Performance of Community Pharmacists in Providing Clinical Medication Reviews

Abstract

Background: Drug-related problems (DRPs) may result in adverse drug reactions causing hospital admissions (5–17%); older patients in particular may experience such reactions during a hospital stay (6–17%). While community pharmacists can identify DRPs through clinical medication reviews, little is known about how well they perform in providing such reviews. Objective: To assess trained community pharmacists' performance in writing care plans and referrals when providing clinical medication reviews to elderly patients as part of a patient outcome–focused Medicines Management project. Methods: In the south of England, 43 community pharmacists were recruited from 80 local community pharmacies; 37 completed clinical pharmacy training to provide medication reviews for elderly patients who were receiving prescriptions for 4 or more medicines from local general practices. Eleven trained pharmacists withdrew and did not provide any reviews. As part of quality assurance, a clinical pharmacist reviewed all care plans and referrals written by the community pharmacists and, if required, amended referrals before they were sent to the patients' family physicians with recommendations. The referrals written by the community pharmacists were compared with those written by the clinical pharmacist and were deemed to be accurate or incomplete (the community pharmacists could provide verbal information to the physicians) if the observations of DRPs and suggestions to solve them were beneficial to patients. Incorrect or missing observations and suggestions were considered non-beneficial to patients. Results: The performance assessment was based on a sample of 244 referrals written by 20 community pharmacists. The clinical pharmacist identified 908 DRPs and suggested 1489 solutions; the community pharmacists beneficially identified 75% of these DRPs (1% were incorrectly identified and 24% were missed) and suggested 58% of the solutions (6% were incorrectly suggested and 36% were missed). Conclusions: The community pharmacists beneficially identified most DRPs and suggested many solutions. However, the assessment may underestimate the community pharmacists' abilities, as it relied on the records they kept and was based on a gold standard. While the pharmacists were self-selected, this study provides valuable insight into trained community pharmacists' clinical medication review performance.