Clinical practice of medication reviews in institutional care settings for older people in the Netherlands: An explorative survey

Introduction: Patient-specific medication reviews might be useful for correcting prescribing omissions. The Dutch Healthcare Inspectorate (IGZ) demands that a medication review is performed by a pharmacist in cooperation with a physician for all residents of nursing homes (twice a year) and residential homes (once a year). Objective: This study aims to show the clinical practice of medication reviews for older people in residential and nursing homes by pharmacists. We asked the following research questions. (i) To what extent are medication reviews performed as required by the IGZ? (ii) How much time is needed to perform the required medication reviews? (iii) In the opinion of the pharmacist, is the medication review economically efficient and medically relevant? Methods: A web-based survey was sent to 87 hospital pharmacists and 270 community pharmacists. Results: In a 'best case vs worst case' scenario, 76% vs 42% of the IGZ-required medication reviews are performed. Considering a mean of 730.7 medication reviews required per year and the mean time spent on one medication review (29.3 min), a pharmacist would need to spend 2.5 months a year to meet the IGZ requirements. Almost every pharmacist considers medication reviews to be medically relevant, but only 47% consider them to be economically efficient. Conclusions: This survey shows that medication reviews performed in institutional care settings do not meet the IGZ requirements, which is not surprising considering the time needed for one medication review. Automation of medication review processes should be initiated to increase efficiency.