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A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. (PKPD)
Hospital Pharmacy, University Hospital of Uppsala, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Rheumatology.
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2009 (English)In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 169, no 9, 894-900 p.Article in journal (Refereed) Published
Abstract [en]


Patients 80 years or older are underrepresented in scientific studies. The objective of this study was to investigate the effectiveness of interventions performed by ward-based pharmacists in reducing morbidity and use of hospital care among older patients.


A randomized controlled study of patients 80 years or older was conducted at the University Hospital of Uppsala, Uppsala, Sweden. Four hundred patients were recruited consecutively between October 1, 2005, and June 30, 2006, and were randomized to control (n = 201) and intervention (n = 199) groups. The interventions were performed by ward-based pharmacists. The control group received standard care without direct involvement of pharmacists at the ward level. The primary outcome measure was the frequency of hospital visits (emergency department and readmissions [total and drug-related]) during the 12-month follow-up period.


Three hundred sixty-eight patients (182 in the intervention group and 186 in the control group) were analyzed. For the intervention group, there was a 16% reduction in all visits to the hospital (quotient, 1.88 vs 2.24; estimate, 0.84; 95% confidence interval [CI], 0.72-0.99) and a 47% reduction in visits to the emergency department (quotient, 0.35 vs 0.66; estimate, 0.53; 95% CI, 0.37-0.75). Drug-related readmissions were reduced by 80% (quotient, 0.06 vs 0.32; estimate, 0.20; 95% CI, 0.10-0.41). After inclusion of the intervention costs, the total cost per patient in the intervention group was $230 lower than that in the control group.


If implemented on a population basis, the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs.

Place, publisher, year, edition, pages
2009. Vol. 169, no 9, 894-900 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-103205DOI: 10.1001/archinternmed.2009.71ISI: 000265994000011PubMedID: 19433702OAI: oai:DiVA.org:uu-103205DiVA: diva2:217803

De 2 första författarna delar förstaförfattarskapet.

De 2 sista författarna delar sistaförfattarskapet.

Available from: 2009-05-15 Created: 2009-05-15 Last updated: 2013-03-12Bibliographically approved
In thesis
1. Effects of Clinical Pharmacists' Interventions: on Drug-Related Hospitalisation and Appropriateness of Prescribing in Elderly Patients
Open this publication in new window or tab >>Effects of Clinical Pharmacists' Interventions: on Drug-Related Hospitalisation and Appropriateness of Prescribing in Elderly Patients
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to evaluate clinical pharmacist interventions with the focus on methods aiming to improve the quality of drug therapy and increase patient safety. Adverse drug events caused by medication errors, suboptimal dosages and inappropriate prescribing are common causes of drug-related morbidity and mortality. Clinical pharmacists integrated in multi-professional health-care teams are increasingly addressing these issues. A randomised controlled trial (RCT) was conducted to investigate the effectiveness of clinical pharmacists’ interventions in reducing morbidity and use of hospital care for patients 80 years or older. The results showed that the intervention group had fewer visits to hospital and that the intervention was cost-effective. In a subsequent study based on the population in the RCT, the appropriateness of prescribing was assessed using three validated tools. The results indicated improved appropriateness of prescribing for the intervention group as a result of the intervention. The tools and the number of drugs at discharge were then tested for validity in terms of causal links between the scores at discharge and hospitalisation. No clear correlations between high scores for the tools or a high number of drugs and increased risk of hospitalisation could be detected. During the inclusion period of the RCT a survey based study was conducted where the perceived value of ward-based clinical pharmacists, from the perspective of hospital-based physicians and nurses as well as from general practitioners (GPs) was evaluated. The respondents were positive to the new collaboration to a high degree and stated increased patient safety and improvements in patients’ drug therapy as the main advantages. In the last study the frequency and severity of prescription and transcription errors, when patients enrolled in the multidose-dispensed medications (MDD) system are discharged from hospital, was investigated. The results showed that errors frequently occur when MDD patients are hospitalised.



Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 58 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 154
Drug-related problems, medication review, appropriateness of prescribing, quality of prescribing, hospitalisation, pharmacist, clinical pharmacy, inter-professional relationships, collaboration, medication error, medication reconciliation, multidose-dispensed medications, prescription errors, transition of care
National Category
Social and Clinical Pharmacy
Research subject
Pharmaceutical Science
urn:nbn:se:uu:diva-167343 (URN)978-91-554-8262-6 (ISBN)
Public defence
2012-03-09, B:8, BMC, Husargatan 3, Uppsala, 09:00 (English)
Available from: 2012-02-17 Created: 2012-01-25 Last updated: 2012-03-01Bibliographically approved

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