***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 
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    Input: The development of indicators to identify ambulatory patients who might benefit from pharmacist monitoring  is described . With the assistance of an eight-member panel of ambulatory-care pharmacists , six prognostic indicators were identified : ( 1 ) five or more medications in present drug regimen , ( 2 ) 12 or more medication doses per day , ( 3 ) medication regimen changed four or more times during the past 12 months , ( 4 ) more than three concurrent disease states present , ( 5 ) history of noncompliance , and ( 6 ) presence of drugs that require therapeutic drug monitoring . The charts of patients who had visited the internal medicine , general surgery , pediatric , and obstetric/gynecology clinics during five r and omly selected weeks in 1985 and 1986 were review ed to determine the presence or absence of the six prognostic indicators and their adverse outcomes . Evidence of drug-therapy-related adverse outcomes was present in 79 ( 33.1 % ) of 239 charts . Charts of patients with a documented history of noncompliance were most likely to show evidence of an adverse outcome . The likelihood that a patient chart would show evidence of an adverse outcome increased as the number of prognostic indicators present increased . The presence of individual or multiple prognostic indicators in the charts of ambulatory-care patients should enable pharmacists to identify patients at greatest risk of experiencing drug-therapy-related adverse outcomes OBJECTIVE The primary objective was to evaluate the effectiveness of a Web-based program , Monitor-Rx , in identifying older adults at risk for drug-related geriatric syndromes or inappropriate medicines . DESIGN This prospect i ve pilot study compared medication related risks generated by the Web-based program with those identified by a certified geriatric pharmacist ( CGP ) . SETTING Wisconsin-based community pharmacy serving primarily older adults . PARTICIPANTS 29 community-dwelling older adults ( mean age : 81.6 years , mean daily medications : 11.7 ) . INTERVENTIONS Each participant received a complete medication history , including self-identified geriatric syndromes . Each participant 's demographic information and medications were entered into Monitor-Rx and concurrently review ed by a CGP . MAIN OUTCOME MEASURES Number of potentially inappropriate medications ( PIMs ) , anticholinergic medicines , and identified geriatric syndromes . RESULTS All participants were identified as at risk for falls by Monitor-Rx and the CGP . Significant medication-related risks identified were urinary incontinence , cognition/memory , nutrition , and dental care . Monitor-Rx identified more participants at risk for geriatric syndromes than the CGP ; however , PIMs were identified more frequently by the CGP . Twenty-six participants self-identified at least one geriatric syndrome . Prevalence of anticholinergic use was more than 75 % . CONCLUSIONS In the participants screened , Monitor-Rx was successful at identifying those with a high risk of drug-related geriatric syndromes . An interview was also important to clarify use of the PIM and to identify whether at-risk participants were actually experiencing the drug related geriatric syndromes . Use of the Web-based tool does not supplant the experience of a well-trained geriatric pharmacist and the professional judgment that comes with that experience Background The magnitude of safety risks related to medications of the older adults has been evidence d by numerous studies , but less is known of how to manage and prevent these risks in different health care setting s. The aim of this study was to coordinate re sources for prospect i ve medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure . Methods Health care units involved in the study are from primary care in Lohja , Southern Finl and : home care ( 191 consented clients ) , the public healthcare center , and a private community pharmacy .  System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession ’s existing re sources in medication risk management of older home care clients . An inventory of clinical measures in usual clinical practice and systematic review of rigorous study design s was utilized in effectiveness study design . Discussion The new coordinated medication management model ( CoMM ) has the following 5 stages : 1 ) practical nurses are trained to identify clinical ly significant drug-related problems ( DRPs ) during home visits and report those to the clinical pharmacist . Clinical pharmacist prepares the cases for 2 ) an interprofessional triage meeting ( 50–70 cases/meeting of 2 h ) where decisions are made on further action , e.g. , more detailed medication review s , 3 ) community pharmacists conduct necessary medication review s and each patients ’ physician makes final decisions on medication changes needed . The final stages concern 4 ) implementation and 5 ) follow-up of medication changes . R and omized controlled trial ( RCT ) was developed to demonstrate the effectiveness of the procedure . The developed procedure is feasible for screening and review ing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care re sources .Trial registration The study is registered in the Clinical Trials.gov ( NCT02545257 ) . Registration date September 9 2015 Various findings of the Impact of Managed Pharmaceutical Care on Re source Utilization and Outcomes in Veterans Affairs Medical Centers ( IMPROVE ) study are review ed . Suggestions for future method ologies that will enhance this study are discussed . The IMPROVE study is one of the largest pharmaceutical care studies conducted . Although it was an intervention study that examined global outcomes following management by pharmacists , it was design ed as an effectiveness study . Several new practice and research methods were developed , including a method to identify patients at high risk for drug-related problems utilizing pharmacy data bases , a method to identify chronic diseases using pharmacy data bases , a method to evaluate the structure and process for delivering pharmaceutical care in Veterans Affairs medical centers ( VAMCs ) , and guidelines for providing care to patients in the IMPROVE study . Nine VAMCs participated in the study , and 1054 patients were r and omized to either an  intervention group  ( n = 523 ) or a  control group ( n = 531 ) . Pharmacists documented a total of 1855 contacts with the intervention group patients and made 3048 therapy-specific interventions over the 12-month study period . There was no meaningful difference in patient satisfaction or quality of life in the two groups . Selected disease-specific indicators found an improved rate of measurement of hemoglobin A1c tests and better control of total and low-density-lipoprotein ( LDL ) cholesterol levels in the intervention group compared with the control group . Total health care costs increased in both groups over the 12-month period . The mean increase in costs in the intervention group was $ 1020 , which was lower than the control group 's value of $ 1313 . The lessons learned from the IMPROVE study suggest to future investigators how to study and measure the effects of clinical pharmacy services on patient outcome STUDY OBJECTIVE To determine if a self-administered question naire can improve the identification of patients at risk for medication-related problems ( MRPs ) compared with usual methods of referral to a pharmacist . DESIGN Prospect i ve , r and omized controlled study . SETTING Multiprofessional primary care clinic at a tertiary care teaching hospital . PATIENTS One hundred ninety-four ambulatory patients aged 18 years or older who were taking at least two drugs . MEASUREMENTS AND MAIN RESULTS Patients completed a five-item , self-administered question naire modified from a tool that was previously vali date d in another population and statistically correlated with the risk of MRPs . Of 194 patients who completed the question naire , 89 were r and omized to the control group ( referral by usual methods ) and 105 were referred according to their responses on the question naire ( intervention group ) . Primary outcomes were the rate of referral and the number of at-risk patients identified . Referral rates were higher with the question naire than with usual methods ( 20 % vs 6 % , p=0.003 ) . Of five patients referred by usual methods , one was at risk for MRPs according to question naire results . Of 84 patients in the control group who were not referred , 12 ( 14 % ) were at risk according to the question naire results ; this finding suggested that several at-risk patients who were not referred by usual methods might have benefitted from a referral for a pharmacist 's assessment . CONCLUSION This self-administered medication risk assessment question naire effectively complemented the usual practice s for identifying and referring patients at risk for MRPs SUMMARY Measurement of patient compliance is essential if management of low compliance is to be performed efficiently . We assessed the ralue of several easily obtained clinical assessment s compared to quantitative pill counts among 134 newly treated hypertensive male steelworkers during the first 6 months of their treatment with antihypertensJve medication .  Patient 's self-reports obtained on structured interview correlated best with pill count compliance ( r = 0.74 , p < 0.0001 ) . Patients overestimated their compliance by an average of 17 % but 90 % of those who admitted to being noocompliant were found so . Qualitative urinary chlorthalidone and hydrochlorothiazide levels and changes in serum potassium , uric acid , and blood pressure also correlated with pill count compliance but were less accurate than interviews . Assessment of the patient's"health beliefs " and a variety of sociodemographic and health traits and perceptions did not provide useful information on compliance . Interviewing the patient is a simple and useful approach in assessing compliance with antihypertensive therapy Background Medication-related problems are a serious concern in Australian primary care .  Pharmacist interventions have been shown to be effective in identifying and resolving these problems . Collaborative general practitioner-pharmacist services currently available in Australia are limited and underused . Limitations include geographical isolation of pharmacists and lack of communication and access to patient information . Co-location of pharmacists within the general practice clinics is a possible solution . There have been no studies in the Australian setting exploring the role of pharmacists within general practice clinics . The aim of this study is to develop and test a multifaceted practice pharmacist role in primary care practice s to improve the quality use of medicines by patients and clinic staff . Methods / design This is a multi-centre , prospect i ve intervention study with a pre-post design and a qualitative component . A practice pharmacist will be located in each of two clinics and provide short and long patient consultations , drug information services and quality assurance activities . Patients receiving long consultation with a  pharmacist will be followed up at 3 and 6 months . Based on sample size calculations , at least 50 patients will be recruited for long patient consultations across both sites . Outcome measures include the number , type and severity of medication-related problems identified and resolved ; medication adherence ; and patient satisfaction . Brief structured interviews will be conducted with patients participating in the study to evaluate their experiences with the service . Staff collaboration and satisfaction with the service will be assessed . Discussion This intervention has the potential to optimise medication use in primary care clinics leading to better health outcomes . This study will provide data about the effectiveness of the proposed model for pharmacist involvement in Australian general practice clinics , that will be useful to guide further research and development in this area . Trial registration Australian New Zeal and Clinical Trials Registry : OBJECTIVES the Medical Research Council Cognitive Function and Ageing Study is a longitudinal study of health and well-being of the ageing UK population . We present the screening interview which assesses how this group copes with activities of daily living ( ADL ) , and characteristic ranges for the total score of these activities by age and DESIGN r and om sampling was from Family Health Service Authority lists in three urban and two rural areas , including institutions . Participants ( n = 13,009 ) in their 65th year and over were interviewed between 1991 and 1994 . The sample was stratified to provide equal numbers in the 65 - 74 and 75 years and over age groups . Each participant was asked about  socio-demographic variables , cognitive function , physical health , medication and ADL  ( based on the nine items from the self-reported Townsend 's disability scale ) . RESULTS the scale shows good reliability and validity in this study . There is a high frequency of disability amongst the oldest old , and relationships between ability and age and between ability and sex and other sociodemographic variables : the risk of having difficulty increases with living away from home , with poorer eyesight and speech , with lower social class and with lack of further education . Projections of the number ( and percentage ) of severely disabled over-65-year-olds  in the UK in 2011 and 2051 are 1.4 million ( 2.2 % ) and 2.3 million ( 3.9 % ) respectively Lack of information about medications coupled with high rates of utilization complicates compliance with medication regimens and increases the risk of adverse effects among older adults . We undertook a study of the efficacy of community-based interventions by pharmacists in a r and omly-allocated one-half of a sample of 284 older adults considered to be at high risk for medication-related problems .  Information and attitudes towards prescription and over-the-counter medications did not differ significantly between the intervention and comparison groups , either before or after the pharmacist interventions . However , visits to physicians were significantly less in the intervention group , suggesting an important if unexpected impact on health-related behavior Background .An objective of pharmaceutical care is for pharmacists to improve patients ’ health-related quality of life ( HRQOL ) by optimizing medication therapy . Objectives .The objective of this study was to determine whether ambulatory care clinical pharmacists could affect HRQOL in veterans who were 
    Output:
    
The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines .