The impact of medication reviews by community pharmacists

Abstract

Objectives Many Canadians use prescription medicines that are unnecessary or that can lead to adverse events. In response, many provinces have introduced programs in which pharmacists are paid to perform medication reviews with patients. As the evidence on such programs is equivocal, we investigated the impact of British Columbia's program. Design Interrupted time series. Setting British Columbia, Canada. Participants All residents of British Columbia who received a medication review between May 1, 2012, and June 30, 2013 (163,776 individuals). Intervention Using British Columbia's population-based PharmaNet drug utilization system, we collected data on community pharmacist–led medication reviews. The PharmaNet database contains a record of all medication reviews conducted in an ambulatory setting. Main outcome measures We studied the impact of first medication reviews conducted between May 2012 and June 2013. We used interrupted time series analysis to assess longitudinal changes in patients receiving a standard review (n = 147,770) and a more intensive pharmacist consultation (n = 16,006). Our outcomes included drug utilization, costs, potentially inappropriate prescriptions, and medication persistence measured through the proportion of commonly used chronic medications that were eventually refilled. Results Overall, we observed few changes in the level or trend of any of the outcomes we studied. Both review types were followed by significant increases in both the number of prescriptions per month and expenditures. The continuation of long-term medications did not change for 3 of 4 classes, and increased very slightly for the final class. We found no evidence of deprescribing, either for classes that are potentially problematic for long-term use (benzodiazepines and proton pump inhibitors) or for potentially inappropriate prescriptions in seniors. Conclusions Our results suggest that medication reviews did not significantly modify prescription drug use by recipients. Future iterations of such programs might be modified to be better targeted and to encourage closer collaboration between pharmacists and prescribing health care professionals.