Evaluation of medication-related problems in medication reviews: a comparative perspective

The elderly population is at a high risk of medication misadventure, with many studies reporting a high number of medication-related problems (MRPs) in this group.

To quantify MRPs in residential facilities routinely reviewed by pharmacists and compare these results with other published findings.

This cross-sectional study included deidentified residents' health and medication data from 6 aged-care facilities. Regular medication reviews had been conducted over 20 years in these facilities. Two hundred ninety-six pharmacist intervention report forms were completed by 3 accredited clinical pharmacists over a 2-year period. These data were then used as a baseline in analyzing other published data for residential aged-care facilities and for patients at home.

A total of 802 (range 0-12 per review) MRPs were identified in patients who were prescribed 2-29 medicines per patient, with a mean of 2.7 MRPs per review (95% CI 2.43 to 2.98). An analysis of the literature showed that the length of treatment, inclusion criteria used, and the definition of MRPs greatly affected the results obtained. However, application of the different inclusion criteria used in other published studies to our data resulted in findings similar to the published Australian average for residents of aged-care facilities and patients living independently at home (3.9 and 4.8 MRPs per patient, respectively).

All medicines can potentially lead to MRPs. MRPs identified during pharmacist medication reviews vary widely between studies but can be normalized by inclusion criteria, length of stay, and the nature of the identified problem. It is recommended that a minimum benchmark for best practice in a patient population receiving at least yearly reviews be less than 3 MRPs per patient. Higher benchmarks of 4 MRPs per patient should apply when the patient population is restricted to include those receiving more than 9 medications and with more than 2 MRPs.