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, José Cristian Plaza‐Plaza, Victoria García‐Cárdenas
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.