Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?

Background: Although pharmacotherapy can be beneficial in the elderly, it can also lead to drug-related problems (DRPs), including untreated indications, drug use without an indication, improper drug selection, subtherapeutic dosage, overdosage, medication error, medication nonadherence, drug interactions, adverse drug reactions, adverse drug withdrawal events, and therapeutic failure.

Objective: The goal of this article was to review evidence from randomized controlled studies to determine whether DRPs and the related health outcomes can be modified by providing clinical pharmacy services for the elderly in community-based settings.

Methods: Randomized controlled studies that assessed DRPs and health outcomes in persons aged > or =65 years after pharmacist interventions were identified through searches of MEDLINE (1970-March 2003), the Cochrane Database of Systematic Reviews (through March 2003), and International Pharmaceutical Abstracts (1966-March 2003). The search combined the terms clinical pharmacists, aged, outcomes, and randomized controlled trial. A manual search of the reference lists of identified articles and the authors' own materials was also conducted.

Results: This literature review included 14 randomized controlled studies: 5 involved interventions in the home health setting, 3 were instituted at hospital discharge with home follow-up, 3 were clinic based, 1 was conducted in the community pharmacy setting, and 2 were conducted in long-term care facilities. These studies provided considerable evidence that clinical pharmacy interventions reduced the occurrence of DRPs in the elderly but showed limited evidence that such interventions reduced morbidity, mortality, or health care costs.

Conclusions: Future large multicenter studies are necessary to test the cost-effectiveness of clinical pharmacy services for the community-based elderly and the impact of these services on such health outcomes as use of health services, timed functional-status measures, and adverse drug reactions.