[Remote drug-review for better use of pharmaceuticals among the elderly]

Annika Kragh, Ewa Rekman
Läkartidningen 2005 April 11, 102 (15): 1143, 1145-6, 1149
During a decade various actions have been taken to decrease the use of inappropriate medication for elderly patients in Sweden. The Swedish Health Department has recently compiled guidelines for inappropriate medication that can be used to evaluate medication in nursing homes for elderly. At the beginning of our project we assessed the medication of persons living in 21 nursing homes in the northeastern district of the county Skåne and based on this analysis we decided that one of the actions to take were drug-reviews. For a period of two years an intensified effort was made to improve medical treatment in nursing homes in the district. Seventeen nursing homes, with 181 patients, were willing to participate. The patients' current medications, state of health (including blood pressure and weight) and known diagnosis were evaluated by a pharmacist and a geriatrician. A specific written recommendation on how to modify drug-usage in these patients were sent to the nursing homes. Decisions were then made by the doctors in charge of the patients on which adjustments to make. At the end of the project 127 patients were reevaluated concerning quality and quantity of medication. A comparison was made before and after the drug-review. Positive results were obtained as well as a lower drug cost. An assessment of the patients' state of health, before and after drug-review, showed a tendency towards improvement. We compared our results with those of a Swedish project that used a different method of drug-review with a visiting pharmacist instead of a written recommendation. The changes in the patients' medication before and after drug-review were the same.

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