BC Clinical impact of medication reviews with follow-up in cardiovascular older patients in primary care: A cluster-randomized controlled trial

Francisco Martínez-Mardones; Shalom I Benrimoj; Antonio Ahumada-Canale; Jose C Plaza-Plaza; Victoria Garcia-Cardenas

doi:10.1111/bcp.15682

BC Clinical impact of medication reviews with follow-up in cardiovascular older patients in primary care: A cluster-randomized controlled trial

Br J Clin Pharmacol. 2023 Jul;89(7):2131-2143. doi: 10.1111/bcp.15682. Epub 2023 Feb 16.

Authors

Francisco Martínez-Mardones¹, Shalom I Benrimoj², Antonio Ahumada-Canale^{1

3}, Jose C Plaza-Plaza⁴, Victoria Garcia-Cardenas¹

Affiliations

¹ Graduate School of Health, University of Technology Sydney, Sydney, Australia.
² Faculty of Pharmacy, University of Granada, Granada, Spain.
³ Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
⁴ Faculty of Chemistry and Pharmacy, Pontifical Catholic University of Chile, Santiago, Chile.

PMID: 36735853
DOI: 10.1111/bcp.15682

Abstract

Aims: Cardiovascular diseases (CVD) are the primary cause of death in Chile. Pharmacist-led medication review with follow-up (MRF) has improved CVD risk factors control in Europe and North America. However, their healthcare systems differ from Chile's, precluding generalizability. This trial aimed to determine the effect of MRF on CVD risk factor control among older patients with polypharmacy attending public primary care centres in Chile.

Methods: A cluster-randomized controlled trial was conducted in 24 centres. Patients older than 65 years with moderate-to-high CVD risk, five or more medications, hypertension, type 2 diabetes or dyslipidaemia, received MRF in addition to usual care or usual care alone for 12 months. Primary outcome measures were clinical goal achievement for hypertension, type 2 diabetes and dyslipidaemia, as well as medication adherence, medication number and CVD risk score. Adjusted generalized estimating equations were used, with odds ratios (ORs) for binary measures and mean differences for continuous measures.

Results: In total, 324 patients from 12 centres (174 MRF group, 150 usual care group, six centres each) received four pharmacist visits. Significant improvements were found for goal achievement in hypertension (OR 4.37, 95% confidence interval [CI] 2.54 to 7.51, P = .001), LDL cholesterol (OR 3.67, 95% CI 2.13 to 6.33, P = .001), type 2 diabetes (OR 6.97, 95% CI 3.69 to 13.2, P = .001), medication adherence (OR 6.60, 95% CI 1.36 to 31.9, P = .022), medications number (-0.86, 95% CI -1.14 to -0.58, P < .001) and CVD risk score (-2.27, 95% CI -2.84 to -1.69, P < .001).

Conclusion: Pharmacist-led medication review with follow-up improved cardiovascular disease risk factor control and medication adherence. This study supports pharmacists' inclusion in primary care teams.

Keywords: cardiovascular risk; hypertension; medication reviews; pharmacist care; primary care; type 2 diabetes.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / drug therapy
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / prevention & control
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / drug therapy
Dyslipidemias* / drug therapy
Dyslipidemias* / epidemiology
Follow-Up Studies
Humans
Hypertension* / drug therapy
Hypertension* / epidemiology
Medication Adherence
Medication Review
Pharmacists
Primary Health Care