Researchers: Shmuel Klang¹, Manuel Katz¹, Olga Brayman ¹, Dorit Dil Nahlieli², Eitan Hyam²

Background: Drug related morbidity and mortality due to multidrug treatments is a highly complex problem, leading to a substantial medical and financial burden. Comprehensive medication reviews (CMRs) can reduce drug related negative outcomes, but this manual process is time-consuming, thus limiting its wide-spread use.

Objectives: Assess whether clinical pharmacists’ use of the MDI system can
(1) Shorten CMR completion time;
(2) Decrease patients’ simulated and actual risk scores;
(3) Reduce treatment costs
(4) Examine the types and adoption rates of recommendations

Method: This prospective, randomized control trial, included patients aged 50 and above, with 6 or more medications, and two or more chronic conditions. 177 patients were randomly assigned into 2 groups (1) CMRs performed without MDI with clinical pharmacists alone (Group “Non MDI”, n=93), and (2) CMRs with clinical pharmacists using the MDI system as a decision support system (Group “MDI”, n=84).

Findings: Recommendations were made for 94% of the patients. A total of 624 recommendations were provided (an average of 3.5 recommendations per patient). The “MDI” group received more safety-related recommendations than the “Non MDI group". The average recommendations’ adoption rate was 53% (no statistically significant difference between the two groups). 25% reduction in time to complete CMRs was reported in the “MDI group” compared to “Non MDI group". Patients’ simulated risk scores were reduced by 24% and actual risks were reduced by 14% after a 9-months follow up. An average total cost reduction of 2921 NIS per patient was found following the intervention.

Conclusions: MDI system identified high risk patients for drug related problems and reduced CMR completion time. Comprehensive medication reviews led to a substantial reduction in the patients’ risk and total cost of care.

Recommendations: Adoption of novel technologies such as MDI system will enable scaling comprehensive medication reviews, optimizing medication treatment and a more efficient utilization of health resources.

Research end date: 08/2023