The HOMER trial is a useful piece of work but raises some important
points with regard to the definition of what is a medication review.
Since no clear definition of a medication review is given within the paper
the conclusions are devalued considerably. The Room for Review document
(available from http://www.medicines-partnership.org/) gives a structure
for reviews at various levels, with the top level involving patient and
pharmacist in consultation with access to the patient's notes. Since home
based consultations may or may not have this access can we assume that the
reviews included in the paper were not at this optimum level? I also
suspect from the information within the paper that most of the effort was
at the level of drug usage review now being built into the new pharmacy
contract. This tends to concentrate on compliance issues. If this is
effective but without appropriate clinical input patients who become
concordant will expect a greater degree of adverse drug reactions as is
pointed out in the paper. If, however, the drug prescribed is
inappropriate as well the likelyhood of adverse events is compounded.
This is why we still have a considerable number of drug related admissions
into hospitals as reported in an earlier BMJ paper published last year.
The other key issue not developed within the paper is the degree of
education and experience of the pharmacists involved together with the
scope of the education and training provided. This is recognised within
the new pharmacy contract with an expectation of a competency assessment
to be in place before such work is undertaken.
I agree with the authors that their study highlights the need for more
research in this very imprtant field but am wary that their paper is being
quoted in various journals without the background. This could set the
agenda for proper medication review back considerably and this would have
a detrimental effect on both the nGMS and the new pharmacy contract. What
is more important is that this evidence, if taken out of context, could
result in patients being denied their medication reviews and therefore
their access to best therapy and advice.
The HOMER trial is a useful piece of work but raises some important
points with regard to the definition of what is a medication review.
Since no clear definition of a medication review is given within the paper
the conclusions are devalued considerably. The Room for Review document
(available from http://www.medicines-partnership.org/) gives a structure
for reviews at various levels, with the top level involving patient and
pharmacist in consultation with access to the patient's notes. Since home
based consultations may or may not have this access can we assume that the
reviews included in the paper were not at this optimum level? I also
suspect from the information within the paper that most of the effort was
at the level of drug usage review now being built into the new pharmacy
contract. This tends to concentrate on compliance issues. If this is
effective but without appropriate clinical input patients who become
concordant will expect a greater degree of adverse drug reactions as is
pointed out in the paper. If, however, the drug prescribed is
inappropriate as well the likelyhood of adverse events is compounded.
This is why we still have a considerable number of drug related admissions
into hospitals as reported in an earlier BMJ paper published last year.
The other key issue not developed within the paper is the degree of
education and experience of the pharmacists involved together with the
scope of the education and training provided. This is recognised within
the new pharmacy contract with an expectation of a competency assessment
to be in place before such work is undertaken.
I agree with the authors that their study highlights the need for more
research in this very imprtant field but am wary that their paper is being
quoted in various journals without the background. This could set the
agenda for proper medication review back considerably and this would have
a detrimental effect on both the nGMS and the new pharmacy contract. What
is more important is that this evidence, if taken out of context, could
result in patients being denied their medication reviews and therefore
their access to best therapy and advice.
David Green
Interface Development Pharmacist
Essex Rivers NHS Trust
Competing interests:
None declared
Competing interests: No competing interests