Medication review in patients using automated drug dispensing systems reduces drug related problems

Introduction There are concerns that automated drug dispensing may increase inappropriate drug use. Automated dispensing could lead to perpetual repeating without necessary re-evaluation. Our objective was to examine the effect of a pharmacist-led medication review on drug-related problems (DRPs) in older patients receiving their drugs by automated dispensing. Materials & Methods Design: A pragmatic randomised controlled study. Setting: Primary care. Patients: Patients were recruited from six Dutch community pharmacies. Patients were eligible if they were home-dwelling, aged 65 years and over and used five or more different drugs of which at least one had to be dispensed in an automated system. Intervention: Patients were randomly allocated to receive a medication review at start of the study (intervention group) or after six months (waiting-list group). Each patient was independently reviewed by two pharmacists. The results of these medication reviews were sent to the community pharmacist to be discussed with the patients' general practitioner (GP). Main outcome measures: The primary outcome measures were: 1. the total number of drug changes 2. the number of drug changes related to a recommendation and 3. the number of DRPs leading to a drug change recommendation. In order to analyse drug changes, medication records were collected six months after the medication review or index date in the Waiting-list Group. Potential DRPs were classified using the D.O.C.U.M.E.N.T. classification1. Results There were no baseline differences between the 63 patients in the intervention group and 55 patients in the waiting-list group regarding age, sex, number of drugs per patient and type of drug prescribed. At baseline, the mean number of DRPs leading to a drug change recommendation was 4.5 per patient and did not differ between both groups. After six months, patients in the intervention group had more drug changes compared to patients in the waiting-list group (2.2 vs. 1.0 per patient, p = 0.02). The number of drug changes related to a recommendation was also higher (1.3 vs. 0.2, p