***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: WHAT IS KNOWN AND OBJECTIVES Little is known about the ability of community pharmacists who are inexperienced in  medication review to identify drug-related problems ( DRPs ) . The objective of our study was to investigate the completeness of DRPs in terms of number , type and clinical relevance identified by community pharmacists when performing home medication review s ( HMRs ) . METHODS This is a cross-sectional study within the intervention arm of a r and omized controlled trial among community-dwelling patients ( ≥65 years , ≥5 drugs ) in ten Dutch community pharmacies . Community pharmacists , who were inexperienced in medication review , received 2-day training in medication review . These pharmacists interviewed patients at home about their medicines , identified potential DRPs and made recommendations in combination with medication and clinical records . Expert review ers completed the number of potential DRPs and recommendations by review ing all available information , including patient interview reports . RESULTS AND DISCUSSION In 155 patients , community pharmacists identified a mean of 3·6 ( SD 2·8 ) potential DRPs per patient and expert review ers added 6·5 ( SD 3·2 ) DRPs . Community pharmacists formulated 2·6 ( SD 2·3 ) recommendations per patient and review ers added 7·5 ( SD 3·3 ) recommendations . Community pharmacists identified a higher proportion of clinical ly relevant DRPs compared with expert review ers , as assessed by DRPs with high priority [ OR = 1·8 ( 95 % CI 1·4 - 2·2 ) ] , DRPs associated with recommendations for drug change [ OR = 1·9 ( 95 % CI 1·5 - 2·3 ) ] and implemented recommendations for drug change [ OR = 2·1 ( 95 % CI 1·6 - 2·7 ) ] . WHAT IS NEW AND CONCLUSION This study shows that the completeness of medication review s by inexperienced community pharmacists with limited training could be improved , although they identified a higher proportion of potentially clinical ly relevant DRPs compared with expert review ers . The results suggest that community pharmacists with limited experience in medication review may need more intensive post-graduate training Background —R and omized controlled trials have demonstrated that collaborative medication review s can improve outcomes for patients with heart failure . We aim ed to determine whether these results translated into Australian practice , where collaborative review s are nationally funded . Methods and Results —This retrospective cohort study using administrative cl aims data included veterans 65 years and older receiving bisoprolol , carvedilol , or metoprolol succinate for which prescribing physicians indicated treatment was for heart failure . We compared those exposed to a general practitioner – pharmacist collaborative home medication review with those who did not receive the service . The service includes physician referral , a home visit by an accredited pharmacist to identify medication-related problems , and a pharmacist report with follow-up undertaken by the physician . Kaplan-Meier analyses and Cox proportional hazards models were used to compare time until next hospitalization for heart failure between the exposed and unexposed groups . There were 273 veterans exposed to a home medicines review and 5444 unexposed patients . Average age in both groups was 81.6 years ( no significant difference ) .  The median number of comorbidities was 8 in the exposed group and 7 in the unexposed ( P<0.0001 ) . Unadjusted results showed a 37 % reduction in rate of hospitalization for heart failure at any time ( hazard ratio , 0.63 ; 95 % CI , 0.44 to 0.89 ) . Adjusted results showed a 45 % reduction ( hazard ratio , 0.55 ; 95 % CI , 0.39 to 0.77 ) among those who had received a home medicines review compared with the unexposed patients . Conclusion —Medicines review in the practice setting is effective in delaying time to next hospitalization for heart failure in those treated with heart failure medicines Background The majority of retirement village residents are at risk of medication misadventure . In a recent survey of retirement village residents in Victoria , two-thirds had at least one medication-related risk factor , and hence were eligible to receive a government-subsidised Home Medicines Review ( HMR ) . However , only 6 % of eligible residents had received a HMR in the previous 12 months . Reasons for the poor uptake of HMR , and interventions for improving HMR uptake , have been identified and developed with input from stakeholders . The trial will test the effect of Pharmacist-conducted HMR to Address the Risk of Medication-related Events in Retirement Villages ( PHARMER ) in improving the uptake of HMRs among retirement village residents . Methods / Design This is a multicentre prospect i ve cluster r and omised controlled trial . Ten retirement villages in Victoria , Australia will be recruited for this trial . Retirement villages will be selected in consultation with the Residents of Retirement Villages Victoria Inc. ( RRVV ) , based on geographical locations ( e.g. northeast or southwest ) , size and other factors . Residents from selected villages will be recruited with the help of RRVV Resident Liaison Officers using a range of strategies . R and omisation will be by geographical location to minimise contamination . Participating villages and residents will be allocated to either  Pharmacist Intervention Group ( PIG ) or Usual Care Group ( UCG ) . Each group will include five retirement villages and will have at least 77 residents in total . The intervention ( PHARMER ) comprises educating residents regarding HMR , and using a risk assessment checklist by residents to notify their General Practitioners of their medication risk . Uptake of HMR and medication adherence will be assessed in both PIG and UCG at three and six months using telephone interviews and question naires . Discussion This study is the first to develop and test an intervention to improve the uptake of HMR among Australian residents in retirement villages , with a view to decreasing medication risk . A multi-faceted interventional approach will be used as suggested by stakeholders . The trial is expected to be complete by late 2011 and results will be available in 2012.Trial Registration Australian New Zeal and Clinical Trials Registry ( ACTRN12611000109909 BACKGROUND Chronic heart failure ( CHF ) accounts for significant morbidity , mortality and health expenditure . Furthermore , patients with CHF are often on numerous pharmacological agents for their comorbidities . The objective of this study was to determine whether a pharmacist directed home medication review intervention had positive effects on CHF patient outcomes . METHODS A total of 120 patients hospitalised for CHF were r and omised to receive a pharmacist directed post-discharge home medication review  ( n = 64 , 53.3 % ) or st and ard care  ( n = 56 , 46.7 % ) . Participants were followed for 6 months . Primary outcomes were death , CHF hospitalisation and length of hospital stay . RESULTS There were no between group differences in mortality ( hazard ratio = 1.41 , 0.50 to 3.97 ; P = 0.514 ) or CHF hospitalizations ( incidence rate ratio [ IRR ] = 1.74 95 % CI : 0.85 - 3.60 P = 0.131 ) over the 6 month follow-up period . Days of hospital stay for CHF exacerbations in the 6 month follow-up were significantly greater in the intervention group ( IRR = 2.34 95 % CI : 1.80 - 3.05 P = 0.000 ) . CONCLUSIONS Post-discharge pharmacy directed home medication review appeared to have no effect on mortality and health care utilisation above that achieved with st and ard care . The post-acute management of CHF must be a collaborative multi-disciplinary effort by the health care team as it is the additive effect of interventions that are most effective Background : Warfarin remains a high-risk drug for adverse events , especially following discharge from the hospital . New approaches are needed to minimize the potential for adverse outcomes during this period . Objective : To evaluate the clinical outcomes of a collaborative , home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review ( HMR ) program . Methods : In a prospect i ve , nonr and omized controlled cohort study , patients discharged from the hospital and newly initiated on or continuing warfarin therapy  received either usual care ( UC ) or a postdischarge service ( PDS )  of 2 or 3 home visits by a trained , HMR-accredited pharmacist in their first 8 to 10 days postdischarge . The PDS involved point-of-care international normalized ratio ( INR ) monitoring , warfarin education , and an HMR , in collaboration with the patient 's general practitioner and community pharmacist . The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge . Secondary outcome measures included the incidences of thrombotic events , combined hemorrhagic and thombotic events , unplanned and warfarin-related hospital readmissions , death , INR control , and persistence with therapy al 8 and 90 days postdischarge . Results : The PDS ( n = 129 ) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 ( 5.3 % vs 14.7 % ; p = 0.03 ) and day 8 ( 0.9 % vs 7.2 % ; p = 0.01 ) compared with UC ( n = 139 ) . The rate of combined hemorrhagic and thrombotic events to day 90 also decreased ( 6.4 % vs 19.0 % ; p = 0.008 ) and persistence with warfarin therapy improved ( 95.4 % vs 83.6 % ; p = 0.004 ) . No significant differences in readmission and death rates or INR control were demonstrated . Conclusions : This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence In patients taking warfarin following hospital discharge . Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care . KEY WORDS : adverse drug events , community pharmacy services , international normalized ratio , patient discharge , warfarin Objective To characterise the nature of the drug-related problems with warfarin therapy identified in  pharmacist-conducted medication review s during a collaborative post-discharge warfarin management service , with a focus on potentially serious drug interactions . Setting Australian community pharmacy practice . Method Medication review reports su bmi tted by pharmacists to patients ’ general practitioners as part of the service were review ed and the type and clinical significance of the warfarin-associated drug-related problems , and the pharmacists ’ recommendations were classified . The prevalence of prescribing of ‘ potentially hazardous ’ warfarin drug interactions was investigated and compared with the frequency of documentation of these interactions in the medication review reports . Main outcome measure The number and nature of warfarin-associated drug-related problems identified and the rate of documentation of ‘ potentially hazardous ’ warfarin drug interactions in the reports from pharmacist-conducted medication review s. Results A total of 157 warfarin-associated drug-related problems were documented in 109 medication review reports ( mean 1.4 per patient , 95 % CI 1.3–1.6 , range 0–5 ) . Drug selection and Education or information were the most commonly identified warfarin-associated drug-related problems ; most drug-related problems were of moderate clinical significance . Eight of 23 potentially serious warfarin drug interactions ( 34.8 % ) were identified in the medication review reports . Conclusion Pharmacists addressing drug selection and warfarin education drug-related problems during medication review s may have contributed to the positive outcomes of the post-discharge service .  Warfarin drug interactions were frequently identified ; however , well-recognised potentially hazardous interactions were under-reported . Improved communication along the continuum of care would permit improved targeting of drug-related problem reporting , especially in relation to preventable drug interactions BACKGROUND Medication-related problems ( MRPs ) are a concern in primary care setting s. Pharmacists based in the community or community pharmacies are able to identify , resolve and prevent MRPs ; however , the lack of a formal partnership with physicians and poor access to patients ' medical records are limitations . In Australia , delivery of pharmacist services within general practice clinics is rare . OBJECTIVES To evaluate the effectiveness of consultations by pharmacists based within primary care medical practice s. METHODS A prospect i ve , before-after intervention study was conducted at two primary health care ( general practice ) clinics in Melbourne , Australia . Participants were clinic patients who had risk-factors for MRPs ( e.g. polypharmacy ) . Patients received a  consultation with the pharmacist  in a private consulting room at the clinic or in their home . The pharmacist review ed the patient 's medication regimen and adherence , with full access to their medical record , provided patient education , and produced a report for the general practitioner . The primary outcome was the number of MRPs identified by the pharmacist , and the number that remained unresolved 6 months after the pharmacist consultation . Secondary outcomes included medication adherence , health service use , and patient satisfaction . RESULTS Eighty-two patients were recruited and 62 ( 75.6 % ) completed the study . The median number of MRPs per patient identified by the practice pharmacist was 2 ( interquartile range [ IQR ] 1 , 4 ) . Six months after review , this fell to 0 ( IQR 0 , 1 ) , P < 0.001 . The proportion of patients who were 
    Output:
    
Evidence supports additional models that promote interprofessional collaboration and timely referral following hospital discharge .
Qualitative research identified low awareness of CMR  among eligible non-recipients , while benefits were perceived to outweigh barriers to implementation .
CONCLUSION The available evidence suggests CMR is beneficial in improving the quality use of medications and health outcomes .