The NHS recommends regular medication reviews for older patients, yet a study published on bmj.com today finds that home based monitoring does not keep older people out of hospital.
The research team identified 872 elderly patients discharged from hospital after an emergency admission. Patients were randomly selected to receive two home visits by a pharmacist (intervention group) or usual care (control group).
The pharmacists educated patients and carers about their drugs, removed out of date drugs, reported possible drug reactions or interactions to the general practitioner, and informed the local pharmacist if a compliance aid was needed.
After six months, 178 emergency hospital admissions had occurred in the control group and 234 in the intervention group, a statistically significant increase of 30% in the intervention group.
This trial shows that home based medication review by a pharmacist increased, rather than decreased, emergency hospital admissions, say the authors. Indeed, the intervention seemed to increase admissions by 30% and home visits by general practitioners by 43%. It also seemed to worsen patients' quality of life compared with controls.
The exact mechanism for this result is not clear, they add. It may be that a better understanding by patients of their conditions led to more hospital admissions. Alternatively, patients may have adhered better to their drugs, with a resultant increase in side effects or drug interactions.
Either way, more effective forms of medication review need to be established, say the authors. The recommendation of the national service framework for older people and the NHS plan that this should be widely introduced in primary care seems to lack a clear evidence base, they conclude.
Annie Ogden, University of East Anglia Press Office, Norwich, UK
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