Annika Dobszai- Institutionen för kliniska vetenskaper, Malmö

Title: Multiprofessional medication reviews for patients in ordinary living – evaluation of outcome and charting a new target group

Main supervisor: Sara Modig, Associate professor, MD, Lund University

Reviewers:  Anne Wissendorff-Ekdahl, Associate professor, MD, Lund University

                      Henning Stenberg, PhD, MD, Lund University

Abstract

Background

Medication treatment contributes to increased survival and improves quality of life; however, it also entails the risk of drug-related problems (DRPs). One method to identify and solve DRPs is medication reviews, a structured evaluation that aims to optimize medication effects and prevent adverse events. 

There are Swedish studies with positive outcome regarding medication reviews in primary healthcare for patients in nursing homes, but more research is needed concerning patients in ordinary living. There is reason to believe that these patients also benefit from medication reviews. 

Research questions

Paper I. Charting patients in ordinary living in primary care, selected for medication reviews, and the identified DRPs.

Paper II. How clinically relevant are the pharmacists’ recommendations within medication reviews? Are they implemented by the general practitioners? Is there a correlation between implementation and different factors in the process?

Paper III. What are general practitioners’ perceptions and experiences of medication reviews for patients in ordinary living? 

Paper IV. What are the patients’ perspectives on medication reviews? 

Preliminary results

Paper I. A total of 109 patients were included in the study. On average 3.9 DRPs per patient were identified. Patients with impaired renal function or ≥10 medications had a significant higher number of DRPs. Published [1].

Paper II. The recommendations from the pharmacists regarding DRPs were judged to have high clinical relevance for the patients. Fewer recommendations per patient, as well as verbal communication in addition to written contact, increased the general practitioners’ tendency to act on the recommendation. Published [2]. 

Paper III. Data collection from focus group discussions is in process.

Paper IV. In-depth interviews with patients are planned.

Significance

The purpose of a medication review is increased safety and quality in the drug treatment. Patients in ordinary living are additionally vulnerable compared to those in institutional settings, since they don’t have the same supervision from healthcare personnel regarding for example side effects. With more knowledge, medication reviews might be carried out to a larger extent in primary healthcare for patients in ordinary living. 

Published studies

1. Wickman K, Dobszai A, Modig S, Bolmsjö BB, Caleres G, Lenander C. Pharmacist-led medication reviews in primary healthcare for adult community-dwelling patients - a descriptive study charting a new target group. BMC Prim Care. 2022 Sep 16;23(1):237. 

2. Dobszai A, Lenander C, Borgström Bolmsjö B, Wickman K, Modig S. Clinical impact of medication reviews for community-dwelling patients in primary healthcare. BMC Prim Care. 2023 Dec 2;24(1):259.