Effect of pharmacist-led medication reviews on appropriateness of prescribing in patients with dementia : results from the cluster randomized controlled “DemStepCare” study

Abstract

Background Patients with dementia (PwD) are often geriatric patients treated with multimedication increasing the risk of drug-related problems (DRP) and inappropriate prescriptions. Pharmacist-led medication reviews are effective to solve DRPs and to improve medication appropriateness. The Medication Appropriateness Index (MAI) is a reliable, valid and standardised tool for detecting multiple dimensions of inappropriate prescribing. The research aimed to evaluate the impact of pharmacist-led medication reviews on medication appropriateness of PwDs as part of the DemStepCare study, using the MAI to categorise potentially inappropriate prescriptions. Methods Comprehensive medication reviews were performed for PwD treated as outpatients over 39 months in the longitudinal, cluster-randomized controlled DemStepCare study by a clinical pharmacist utilizing the project-specific, electronic patient record. Modified MAI scores were calculated at baseline and over the course of the study in the intervention group (IG) and control group (CG) at predefined time points. Only in the interventional arm, responsible GPs were informed about the result of the medication review and the pharmacist’s recommendation to improve medication appropriateness. Results 198 PwDs were enrolled in the IG and 47 PwDs in the CG (intention-to-treat collective). For IG patients, the modified MAI sum (SS) and patient score (PS) decreased significantly (p < 0.001) until t1, i.e. over the first 9 or 11 months of the study (baseline: SS = 15.24 ± 12.78; PS = 2.10 ± 1.53 / t1: SS = 7.50 ± 9.54; PS = 0.97 ± 1.13). The number of DRPs in this period was significantly reduced as well. Conclusion

Even a single comprehensive medication review significantly improved medication appropriateness in PwD. Based on the results, pharmacist-led medication reviews are strongly recommended for PwDs.