Homebased Medication Review

The recently published HARM study found that 2,4% of all hospital admissions
and 5,6% of all acute admissions in the Netherlands were drug related. Of these
admissions 46% were considered *possibly avoidable*. Drug related problems are
a considerable risk for patient safety, especially among patients using
multiple chronic medicines. Regular and systematic review of individual
patient*s drug treatment can help to reduce the number of drug related problems
en may improve patient outcome. The Medication Home Visit (FTC) project of
LLOYDS Pharmacies is based on the Australian Home Medicines Review (HMR).
During this project a pharmacy-led medication review will be performed based on
the patient*s medication list, GP clinical notes and information from a
patient*s home-interview. The intervention will be performed and monitored by a
community pharmacist in close collaboration with the patient*s GP. The present
study examines the possibility to implement the FTC intervention in primary
care in the Netherlands and the effect of the FTC intervention on the quality
of pharmacotherapy and clinical outcomes.

The objective of this study is to examine whether the FTC-intervention improves
the quality of pharmacotherapy in individual patients.

A randomized-controlled intervention trial. After informed consent patients are
randomized to an intervention or control group, using the GP as unit of
randomization.

A medication review will be performed by the patient*s pharmacist, using the
medication list and GP clinical records. The medication review is evaluated
and, if necessary, completed by an independent pharmacist panel. All potential
drug related problems are identified and classified. The pharmacist visits the
patient at home for an interview about the patient*s medicines and to identify
other possible drug related problems. The medication review will be completed
using the information from the patient*s interview. Adjustments in
pharmacotherapy will be proposed and discussed with the patient*s GP. A
treatment plan will be formulated. The GP or pharmacist will discuss the
treatment plan with the patient. Patients in the control group receive regular
care.

The risk and burden for patients in this study is limited, because the
intervention is embedded in regular care. However, potential drug related
problems may be identified and therefore adjustments in pharmacotherapy may be
proposed. This may raise patient*s concerns for not receiving optimal treatment
in the period before the intervention. We will try to minimize this risk, by
fully informing the patient, GP and pharmacists about the intervention and the
possible consequences for treatment.