A randomised controlled trial of the effects of note-based medication review by community pharmacists on prescribing of cardiovascular drugs in general practice

Abstract

Objective Recent trends in primary care have seen closer working relationships between community pharmacists and general practitioners (GPs) in an attempt to improve the effectiveness and efficiency of prescribing. Community pharmacists are appropriate for a role in the management of prescribed medicines because of their detailed training in pharmacology, therapeutics and pharmaceutics. The aim of this project was to quantify the benefit of a general practice-based, community pharmacist-led, note-based medication review of patients with hypertension or angina.Method Trained community pharmacists (20), attached to Grampian general practices (43), reviewed repeat prescriptions of a random sample of patients taking cardiovascular drugs for the treatment of angina or hypertension, and made recommendations to the GP for changes, where appropriate. The effect of the pharmaceutical intervention was measured in terms of prescribing indicators, patient outcomes (quality of life, symptom control), and physiological and biochemical markers at baseline, 6 and 12 months. A control group was treated following standard practice. An economic evaluation of the interventions was also conducted.Key findings The baseline standard of treatment as measured against guidelines was good. At 12 months, there was a small improvement in prescribing of antiplatelet drugs, but overall changes were minimal. Average overall cost per patient was higher in the intervention group. The quality of life measures showed no change between the groups.Conclusions Improvements in the intervention group were small and less than in other reported studies of pharmacist interventions. The National Health Service (NHS) costs of the intervention group were higher than those of the controls. Note-based medication review by community pharmacists was found to be associated with minimal changes in prescribing.