• Alan Lukazewski, Beth Martin, Dimmy Sokhal, Kathy Hornemann, and Ann Schwartzwald.
• Pharmacy Services, Oakwood Village Retirement Communities, Madison, Wisconsin. USA.
• Consult Pharm. 2014 Oct 1; 29 (10): 689-97.

ObjectivePrimary, to evaluate the usefulness of a comprehensive medication review (CMR) process in screening for adverse drug event (ADE) risk and to measure the impact of pharmacist recommendations; secondary, to evaluate whether screening tools assist in detecting ADEs.DesignNonrandomized, prospective pre/post pilot study.SettingWisconsin-based community pharmacy affiliated with a two-campus retirement facility serving independently living older adults.ParticipantsSixty-nine older adults responded to the initial call for participation in the ADE screening (mean age 84 years, mean daily medications: 13.7). Thirty-nine older adults (mean age 86 years, mean daily medications: 13.8) participated in both pre/post pilot study phases.InterventionEach participant received a CMR, including self-identified geriatric syndromes and St. Louis University Memory Screen (SLUMS) assessment. Recommendation letters included lifestyle changes to reduce medication use. A three-month follow-up call gathered current medication lists and recommendation acceptance rates. Repeat screenings were also conducted.Main Outcome Measure(S)Number of ADEs identified, recommendation acceptance rates, medication-related changes. Secondary measures: self-reported geriatric syndromes, SLUMS scores associated with ADE identification, screening tools associated with ADE identification.ResultsPharmacist-initiated CMRs resulted in a high rate of discontinued nonsteroidal anti-inflammatory drugs (NSAIDs) and overall reduction in the number of scheduled medications. Participants with a positive ADE history were significantly more likely to report a suspected current ADE. Pharmacists incorporated nonpharmacologic interventions for reported geriatric syndromes, with high participant acceptance rates. In isolated cases, cognition was measurably improved with discontinuation of a targeted medication.ConclusionsPharmacist-provided CMR services should be comprehensive, including patient's self-report of ADEs and history of ADEs. Pharmacist intervention can minimize prescription medication use, reducing the risk of ADEs.

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