Richard Holland, BA, BM BCh, DA, DPH, MFPH, PhD, Senior Lecturer in Public Health Medicine, School of Medicine Health Policy & Practice, University of East Anglia, Norwich, UK.
David Wright, BPharm, PhD, Senior Lecturer in Pharmacy Practice, School of Chemistry and Pharmacy, University of East Anglia, Norwich, UK.

Older people consume a disproportionate quantity of drugs compared to younger people. Furthermore, the volume and cost of these drugs is increasing markedly. In theory, drugs are prescribed to reduce both morbidity and mortality but can also cause harm, particularly amongst older people. Medication review has been advocated as a technique to reduce such problems, whilst at the same time ensuring patients gain maximum benefit from their drugs. Whilst medication review seems a logical solution to inappropriate prescribing in general and adverse reactions in particular, evidence that specific interventions are effective at reducing morbidity or mortality is lacking.
Key words: medication review, adverse drug reactions, medication appropriateness, pharmacists, background.

Eleanor Brownridge

Who does a patient call when wondering why a drug is not working, when concerned about an adverse reaction to a drug, or when hearing on the radio that green vegetables interfere with Coumadin?

Faced with absorbing so much verbal advice about their disease, diet, and life-style changes, it is no wonder that so many patients experience information overload. Once home and starting on a treatment, new questions arise.

Thirteen years of experience by the Medication Information Line for the Elderly (MILE) in Manitoba suggests that many older people are reluctant to call their physician with a drug-related concern for fear of being an economic burden to the healthcare system or just appearing foolish. They do not consult their regular pharmacist either because it did not occur to them that the pharmacist could provide such information, or because they thought the pharmacist was too busy.

Ruby Grymonpré, PharmD, associate professor at the Faculty of Pharmacy, University of Manitoba started MILE in January 1985, to fill a drug information gap for elderly consumers in Manitoba, many of whom are housebound or living in isolated rural areas. Funding for the annual $85,000 budget has come from Manitoba Health, University of Manitoba and individual drug manufacturers. Available weekdays from 9 am to 3 pm, MILE pharmacists log an average of 200 calls a month.