International Journal of Clinical Pharmacy

, Volume 33, Issue 3, pp 549–557 | Cite as

Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes

  • Melanie Isabelle BrulhartEmail author
  • Joel Pierre Wermeille
Research Article


Objective The objective of this study was to assess implementation of a pharmaceutical care model for the multidisciplinary care of elderly patients in nursing homes. Setting Prospective study, medication review, from January 2007 to December 2009 in ten nursing homes affiliated to the Pharmacie interjurassienne (PIJ), Switzerland. Method Medication use data were collected and reviewed by a pharmacist, focusing on drug indication, dosing, side effects, renal/hepatic elimination and interactions. Drug-related problems (DRPs) were discussed face-to-face with the responsible physician and a nurse. The pharmaceutical care issues were formulated and medication interventions proposed during this meeting. DRPs and interventions were documented using the Pharmaceutical Care Network Europe scheme version 5.00 (PCNE V5.00). The economic impact of the service was estimated through a retrospective evaluation of annual drug costs. A satisfaction evaluation was conducted among practitioners and nurses. Main outcome measures DRPs, interventions, treatment changes implemented. Results Drug therapy of 329 patients was reviewed. The number of medicines per patient ranged from 2 to 27 (mean 12.8). A total of 1,225 DRPs were detected and discussed with the physician and the nurse. Medication review led to 343 medical evaluations secondary to drug-drug interactions and 803 treatment adaptations: 373 drugs were stopped, 197 dosages changed, 95 instructions for use amended, 86 drug choices were altered, 35 drug formulations changed and 17 new drugs started. According to the Anatomical Classification System, the main classes involved in interventions were related to Alimentary tract and metabolism (n = 285), Nervous system (n = 189) and Cardiovascular system (n = 115). Since the outset of the PIJ, the annual drug costs decreased in nursing homes with medication review including a pharmacist, whereas it was stable in the other nursing homes. The satisfaction evaluation showed a very positive appreciation by practitioners and nurses. Conclusion The study showed an efficient pharmaceutical care model, well accepted by physicians and nurses. It also indicated that for elderly patients, continuous drug review contributed to improved drug therapy, reduced unnecessary polypharmacy and reduced pharmaceutical costs.


Clinical pharmacist Drug-related problems Elderly Medication review Nursing home PCNE DRP classification Polypharmacy Switzerland 



The authors thank all practitioners and all the whole staffs of the nursing homes for their participation in the study.


The present study was funded by the Research Funds of the Pharmacie interjurassienne.

Conflicts of interest

M. Brulhart and J. Wermeille work for the Pharmacie interjurassienne, which provided medicines and pharmaceutical services to the hospitals and nursing homes of Jura and Bernese Jura area, including the nursing homes involved in the study.


  1. 1.
    Swiss Office of Statistics. Press communication no. 0351-0714-50 [document on the internet]. Neuchâtel, Switzerland: Federal Office of Statistics; 2007 Dec 10 [updated 2010 Oct 20; cited 2010 Jan 08]. Available from:
  2. 2.
    Swiss Office of Statistics. Press communication no. 0351-0803-60 [document on the internet]. Neuchâtel, Switzerland: Federal Office of Statistics; 2008 Apr 22 [updated 2010 Oct 20; cited 2010 Jan 08]. Available from:
  3. 3.
    Fontannaz J-R. Les tarifs des homes subissent de fortes variations [Prices in nursing homes are under strong variations]. Bilan [serial on the internet]. 2008 May; [updated 2010 Oct 20; cited 2010 Jan 08]; 250: [about 5 screens]. Available from:
  4. 4.
    Government of Le Jura Republic. Government information to the Parliament of Le Jura Republic about the future organisation of nursing homes [document on the internet]. Delémont, Switzerland; 2009 Nov 17 [updated 2010 Oct 20; cited 2010 Jan 08]. Available from:
  5. 5.
    Grenier-Gosselin L. Portrait de la population gériatrique et médicaments problématiques chez cette clientèle [Elderly patients and drug problems in this population]. Pharmactuel. 2008;41:6–10.Google Scholar
  6. 6.
    Zarowitz BJ, Stebelsky LA, Muma BK, Romain TM, Peterson EL. Reduction of high-risk polypharmacy drug combinations in patients in a managed care setting. Pharmacotherapy. 2005;25:1636–45.PubMedCrossRefGoogle Scholar
  7. 7.
    Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:314–6.CrossRefGoogle Scholar
  8. 8.
    Rossi M, Young A, Maher R, Rodriguez K, Appelt C, Perera S, et al. Polypharmacy and health beliefs in older outpatients. Am J Geriatr Pharmacother. 2007;5:317–23.PubMedCrossRefGoogle Scholar
  9. 9.
    Wawruch M, Zikavska M, Wsolova L, Kuzelova M, Tisonova J, Gajdosik J, et al. Polypharmacy in elderly hospitalised patients in Slovakia. Pharm World Sci. 2008;30:235–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Spinewine A, Swine C, Dhillon S, Franklin BD, Tulkens PM, Wilmotte L, et al. Appropriateness of use of medicines in elderly inpatients: qualitative study. BMJ [serial on the internet]. 2005 Aug 10; [updated 2010 Oct 20, cited 2005 Nov 02]; 331: 935: [about 10 screens]. Available from:
  11. 11.
    Beuzit K, Arnaud A, Remblier C, Haas M, Perault M-C. Analyse de prescriptions en institution gériatrique [Prescription analysis in nursing homes]. Journal de Pharmacie Clinique. 2003;22:18–22.Google Scholar
  12. 12.
    Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370:173–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet. 2007;370:185–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Wynne HA. Adverse drug reactions in old age. Adverse Drug React Bull. 2006;237:907–10.CrossRefGoogle Scholar
  15. 15.
    Alcalde E, Guerrero M, Pérez G, Moreno C. Measures to reduce pharmaceutical costs in Spanish nursing homes. EJHP-Sci. 2009;15:20–4.Google Scholar
  16. 16.
    Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother. 2009;43:1096–106.PubMedCrossRefGoogle Scholar
  17. 17.
    Ampe E, Spinewine A, Wilmotte L, Hecq J-D, Tulkens PM. La pharmacie clinique: un développement récent de l’activité des pharmaciens pour une prise en charge optimisée des patients du point de vue médicamenteux [Clinical pharmacy: a recent development of pharmacist activity to optimise patient medication]. Louvain Medical. 2006;125:273–86.Google Scholar
  18. 18.
    Hanlon JT, Lindblad CI, Gray SL. Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults? Am J Geriatr Pharmacother. 2004;2(1):3–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Stuijt CC, Franssen EJ, Egberts AC, Hudson SA. Appropriateness of prescribing among elderly patients in a Dutch residential home: observational study of outcomes after a pharmacist-led medication review. Drug Aging. 2008;25:947–54.CrossRefGoogle Scholar
  20. 20.
    Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older. Arch Intern Med. 2009;169:894–900.PubMedCrossRefGoogle Scholar
  21. 21.
    Linnebur SA, O’Conell MB, Wessell AM, McCord AD, Kennedy DH, DeMaagd G, et al. Pharmacy practice, research, education, and advocacy for older adults (ACCP White Paper). Parmacotherapy. 2005;25:1396–430.CrossRefGoogle Scholar
  22. 22.
    Perez A, Doloresco F, Hoffman JM, Meek PD, Touchette DR, Vermeulen LC, et al. Economic evaluations of clinical pharmacy services: 2001–2005 (ACCP). Parmacotherapy. 2008;28:285–323.CrossRefGoogle Scholar
  23. 23.
    June Gibbs Brown, Inspector general. Prescription drug use in nursing homes [document on the internet]. Texas: Departement of Health and Human Services, Office of inspector general; 1997 Nov. Report 2 [updated 2010 Oct 20; cited 2010 Jan 08]. Available from:
  24. 24.
    Pharmaceutical Care Network Europe Foundation. PCNE Classification for drug-related problems V5.00 [document on the internet]. 2007 Oct 03; [updated 2010 Oct 20; cited 2006 Aug 2]. Available from:
  25. 25.
    Vonbach P, Dubied A, Krähenbühl S, Beer JH. Evaluation of frequently used drug interaction screening programs. Pharm World Sci. 2008;30:367–74.PubMedCrossRefGoogle Scholar
  26. 26.
    Foppe van Mil JW, Tommy Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38:859–67.CrossRefGoogle Scholar
  27. 27.
    Lampert ML, Krähenbühl S, Hug BL. Drug-related problems: evaluation of a classification system in the daily pratice of a Swiss university hospital. Pharm World Sci. 2008;30:768–76.PubMedCrossRefGoogle Scholar
  28. 28.
    Klopfer JD, Einarson TR. Acceptance of pharmacists’ suggestions by prescribers: a literature review. Hosp Pharm. 1990;25:830–6.PubMedGoogle Scholar
  29. 29.
    Montgomery AT, Kälvemark-Sporrong S, Henning M, Tully MP, Kettis-Lindblad A. Implementation of a pharmaceutical care service: prescriptionists’, pharmacists’ and doctors’ views. Pharm World Sci. 2007;29:593–602.PubMedCrossRefGoogle Scholar
  30. 30.
    Langebrake C, Hilgarth H. Clinical pharmacists’ interventions in a German university hospital. Pharm World Sci. 2010;32:194–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Benoît P, Mangerel K, Garreau T, Vonna P, Juste M. Evaluation des moyens mis en œuvre et acceptation d’une présence pharmaceutique dans les services de soins [Evaluation of requirements and acceptance of a pharmaceutical presence in wards]. Journal de Pharmacie Clinique. 2007;26:83–90.Google Scholar
  32. 32.
    Galindo C, Olivé M, Lacasa C, Martinez J, Roure C, Llado M, et al. Pharmaceutical care: pharmacy involvement in prescribing in acute-care hospital. Pharm World Sci. 2003;25:56–64.PubMedCrossRefGoogle Scholar
  33. 33.
    Chatsisvili A, Sapounidis I, Pavlidou G, Zoumpouridou E, Karakousis VA, Spanakis M, et al. Potential drug-drug interactions in prescriptions dispensed in community pharmacies in Greece. Pharm World Sci. 2010;32:187–93.PubMedCrossRefGoogle Scholar
  34. 34.
    Loca JF, Rüggli M, Buchmann M, Huguenin J, Bugnon O. Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton. Pharm World Sci. 2009;31:165–73.CrossRefGoogle Scholar
  35. 35.
    Bootman JL, Harrison LDL, Cox E. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med. 1997;157:2089–96.PubMedCrossRefGoogle Scholar
  36. 36.
    Patterson SM, Hughes CM, Lapane KL. Assessment of a United States pharmaceutical care model for nursing homes in the United Kingdom. Pharm World Sci. 2007;29:517–25.PubMedCrossRefGoogle Scholar
  37. 37.
    Roberts MS, Stokes JA, King MA, Lynne TA, Purdie DM, Glasziou PP, et al. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol. 2001;51:257–65.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Melanie Isabelle Brulhart
    • 1
    Email author
  • Joel Pierre Wermeille
    • 1
  1. 1.Pharmacie interjurassienne (PIJ)Hospitals and Nursing homes of Jura and Jura bernois SAMoutierSwitzerland

Personalised recommendations