Impact of the automated dose dispensing with medication review on geriatric primary care patients drug use in Finland: a nationwide cohort study with matched controls.

OBJECTIVE: In an automated dose dispensing (ADD) service, medicines are dispensed in unit-dose bags according to administration times. When the service is initiated, the patient's medication list is reconciled and a prescription review is conducted. The service is expected to reduce drug use. The aim of this national controlled study was to investigate whether the ADD service with medication review reduces drug use among geriatric primary care patients. DESIGN, SETTING AND PATIENTS: This is a nationwide cohort study with matched controls. The study group consisted of all primary care patients ≥65 years enrolled in the ADD service in Finland during 2007 (n = 2073). Control patients (n = 2073) were matched by gender, age, area of patient's residence and number of the prescription drugs reimbursed. The data on all prescription drugs reimbursed during the 1 year periods before and after the ADD service enrollment were extracted from the Finnish National Prescription Register. Drug use was calculated as defined daily doses (DDD) per day. RESULTS: The studied 20 most used drugs covered 86% of all reimbursed drug use (in DDD) of the study group. The use of 11 out of these 20 active substances studied was reduced significantly (p < .001-.041) when the drug use was adjusted by the number of chronic diseases. Two of these drugs were hypnotics and six were cardiovascular system drugs. CONCLUSIONS: Drug use was decreased after initiation of the ADD service in primary care patients ≥65 years compared to matched controls in this 1 year cohort study. Further studies should be conducted in order to explore the causality, assess the ADD service's impact on drug use quality and costs, as well as impact of accompanied prescription review on positive outcomes.

Starting an automated dose dispensing service provided by community pharmacies in Finland.

BACKGROUND: In an automated dose dispensing (ADD) service, medicines are packed in unit-dose bags according to administration times. When the service is initiated, the patient's medication list is reconciled and the medication is reviewed on the basis of this list. OBJECTIVE: The aim of this national study was to investigate how the medication list was reconciled, what type of medication review was conducted, and what changes were made to the patient's medications when the ADD service is initiated. SETTING: Primary care in Finland. METHOD: All patients enrolled in the service during a 3-week period in autumn 2010 were included in the study. All community pharmacies (n = 267) purchasing unit-dose bags from Espoonlahti Pharmacy documented the actions taken in the ADD initiation process using a structured data collection sheet. MAIN OUTCOME MEASURE: Information sources needed in medication reconciliation, the type of medication review conducted and changes made to patients' medications. RESULTS: Documentation was completed for 147 out of 325 new ADD users resulting 45 % as a response rate. More than one source was needed for 63 % of the patients in medication reconciliation. The most common sources used were nursing staff (72 % of the patients) and an existing medication list (71 %). Some type of medication review, most commonly a prescription review, was conducted for the majority of the patients (96 %), usually in multi-professional collaboration. Treatment-related changes were made for 43 % of the patients and technical changes were made for 93 % of the patients. CONCLUSION: The medication list was incomplete for more than half of the patients. Some type of medication review was conducted for most of the patients. Both treatment-related changes and technical changes were made on patients' medications during the initiation process. The start-up process of the ADD service needs further development to ensure a standard procedure and optimum use of resources.

Automated dose dispensing service for primary healthcare patients: a systematic review.

BACKGROUND: An automated dose dispensing (ADD) service has been implemented in primary healthcare in some European countries. In this service, regularly used medicines are machine-packed into unit-dose bags for each time of administration. The aim of this study is to review the evidence for ADD's influence on the appropriateness of medication use, medication safety, and costs in primary healthcare. METHODS: A literature search was performed in April 2012 in the most relevant databases (n = 10), including the Medline, Embase, and Cochrane Library. The reference lists of the studies selected were manually searched. A study was included in the review if the study was conducted in primary healthcare or nursing home settings and medicines were dispensed in unit-dose bags. RESULTS: Out of 328 abstracts, seven studies met the inclusion and reporting quality criteria, but none applied a randomized controlled study design. Of the four controlled studies, one was a national register-based study. It showed that the patient group in the ADD scheme more often used three or more psychotropic drugs and anticholinergics than patients using the standard dispensing procedure, while women in the ADD group used less long-acting benzodiazepines and both genders had fewer drug-drug interactions. In another, regional controlled study, the ADD group consisted of patients with higher risk of inappropriate drug use, according to all indicators applied. The third controlled study indicated that ADD user drug treatments were more likely to remain unchanged than in patients using a standard dispensing procedure. A controlled study from Norway showed that ADD reduced discrepancies in the documentation of patient medication records. Costs were not investigated in any of the studies. CONCLUSIONS: A very limited number of controlled studies have explored ADD in primary healthcare. Consequently, the evidence for ADD's influence on appropriateness and safety of medication use is limited and lacking in information on costs. The findings of this review suggest that patients using the ADD have more inappropriate drugs in their regimens, and that ADD may improve medication safety in terms of reducing the discrepancies in medication records. Further evidence is needed to draw sound conclusions on ADD's outcomes.