Introduction
The need for regular medication review has been recognised in the recently introduced GP contract in the UK and new Community Pharmacy contract for England and Wales. The effectiveness of medication review in general practice has been demonstrated previously1,2 A further study of community pharmacy based clinical medication review demonstrated resolution of drug therapy problems with clinical review versus standard care 3. The model tested in this study provided community pharmacists with summary medical profiles derived from patient's medical records. Currently community pharmacists do not have routine access to patient's medical records and this is perceived to be a barrier to delivering a clinical medication review service. The aim of this present study was to compare the effectiveness of community pharmacy based clinical medication review with and without access to patient's summary medical profiles.

Method
The recruitment and accreditation of community pharmacists has been described previously4. Patients aged ? 65yrs, receiving 4 or more repeat medicines simultaneously, were identified from participating GP practice lists. Consenting patients who nominated a participating pharmacy were randomised into one of two intervention groups. The active group received a clinical medication review without access to patient's medical profiles while the control group received a clinical medication review with access to patient's medical profiles. The clinical medication review process was based upon an established evaluated model 1. Patients, GPs and the principle investigator were blinded throughout the study.

Results
480 patients (87%) registered with 20 GP practices received their allocated intervention across 16 community pharmacies. Both active and control groups were matched at baseline. The mean number of cDTPs identified was 1.7 ± 1.4 for the active group and 1.9 ± 1.3 for the control group (p = 0.078). Of the 13 cDTP categories only three had a significant difference with 'untreated indication' (p < 0.01) higher in the control group and 'adverse drug reaction' (p<0.05) and 'cost-effectiveness' (p< 0.05) higher in the active group. Follow up after 1 year revealed no significant difference in the resolution of cDTPs, with 61% resolved in the active group compared with 57% in the control group.

Discussion
Trained and accredited community pharmacists in collaboration with GPs were able to identify and resolve a broad range of cDTPs. Lack of access to patient's summary medical profiles did not significantly impact upon the number of cDTPs identified and subsequently resolved. Small differences were noted in the nature of the cDTPs with more 'untreated indications' being detected by the pharmacists with access to medical summaries. These findings are significant in light of the new 'Medicines Use Review' Service which requires accredited community pharmacists to undertake a review of medicines out with the GP practice, without access to medical notes and communicated by written referral.