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

Martínez-Mardones, F; Benrimoj, SI; Ahumada-Canale, A; Plaza-Plaza, JC; Garcia-Cardenas, V

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

Martínez-Mardones, F Benrimoj, SI Ahumada-Canale, A Plaza-Plaza, JC Garcia-Cardenas, V

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Publisher:: WILEY
Publication Type:: Journal Article
Citation:: Br J Clin Pharmacol, 2023, 89, (7), pp. 2131-2143
Issue Date:: 2023-07

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Field	Value	Language
dc.contributor.author	Martínez-Mardones, F
dc.contributor.author	Benrimoj, SI
dc.contributor.author	Ahumada-Canale, A
dc.contributor.author	Plaza-Plaza, JC
dc.contributor.author	Garcia-Cardenas, V
dc.date.accessioned	2023-10-05T03:46:12Z
dc.date.available	2023-01-29
dc.date.available	2023-10-05T03:46:12Z
dc.date.issued	2023-07
dc.identifier.citation	Br J Clin Pharmacol, 2023, 89, (7), pp. 2131-2143
dc.identifier.issn	0306-5251
dc.identifier.issn	1365-2125
dc.identifier.uri	http://hdl.handle.net/10453/172513
dc.description.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.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	WILEY
dc.relation.ispartof	Br J Clin Pharmacol
dc.relation.isbasedon	10.1111/bcp.15682
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1115 Pharmacology and Pharmaceutical Sciences
dc.subject.classification	Pharmacology & Pharmacy
dc.subject.classification	3214 Pharmacology and pharmaceutical sciences
dc.subject.mesh	Humans
dc.subject.mesh	Diabetes Mellitus, Type 2
dc.subject.mesh	Follow-Up Studies
dc.subject.mesh	Medication Review
dc.subject.mesh	Hypertension
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Dyslipidemias
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Medication Adherence
dc.subject.mesh	Pharmacists
dc.subject.mesh	Humans
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Hypertension
dc.subject.mesh	Diabetes Mellitus, Type 2
dc.subject.mesh	Follow-Up Studies
dc.subject.mesh	Pharmacists
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Dyslipidemias
dc.subject.mesh	Medication Adherence
dc.subject.mesh	Medication Review
dc.subject.mesh	Humans
dc.subject.mesh	Diabetes Mellitus, Type 2
dc.subject.mesh	Follow-Up Studies
dc.subject.mesh	Medication Review
dc.subject.mesh	Hypertension
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Dyslipidemias
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Medication Adherence
dc.subject.mesh	Pharmacists
dc.title	BC Clinical impact of medication reviews with follow-up in cardiovascular older patients in primary care: A cluster-randomized controlled trial.
dc.type	Journal Article
utslib.citation.volume	89
utslib.location.activity	England
utslib.for	1115 Pharmacology and Pharmaceutical Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	open_access	*
dc.date.updated	2023-10-05T03:46:10Z
pubs.issue	7
pubs.publication-status	Published
pubs.volume	89
utslib.citation.issue	7

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.

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