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Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients
George Pope1, Noreen Wall, Catherine Mary Peters
1Mid Western Regional Hospital, Clinical Age Assessment Unit, Limerick, Ireland. georgepopea@gmail.com
Objectives:
to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care.
Design:
prospective, randomised, controlled trial.
Setting:
two residential continuing care hospitals.
Participants:
two hundred and twenty-five permanent patients.
Intervention:
patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months.
Results:
one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213).
Conclusion:
specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.
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