OBJECTIVES: To identify medication review interventions for older adults that involve community pharmacists and evidence of outcomes of these interventions.
DESIGN: Systematic review.
MEASUREMENTS: Cinahl, MEDLINE (Ovid), Scopus, International Pharmaceutical Abstracts, and Cochrane Library were searched for articles published between January 2000 and February 2016. Articles involving community pharmacists in medication reviews for outpatients aged 65 and older were included. Evidence of economic, clinical, and humanistic outcomes of interventions was summarized.
RESULTS: Sixteen articles were found that described 12 medication review interventions, of which 6 were compliance and concordance reviews, 4 were clinical medication reviews, and 2 were prescription reviews according to a previously developed typology. Community pharmacists' contributions to reviewing medications varied from sending the dispensing history to other healthcare providers to comprehensive involvement in medication management. The most commonly assessed outcomes of the interventions were medication changes leading to reduction in actual or potential drug-related problems (n=12) and improved adherence (n=5).
CONCLUSION: Regardless of community pharmacists' contributions to interventions, medication review interventions seem to reduce drug-related problems and increase medication adherence. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacists' contributions to reviewing medications and improving the health of older adults.
A very interesting article in that it provides food for thought for community nurses to collaborate more closely with community pharmacists in reviewing their patients' medications to improve their compliance and potentially their quality of life and, as some studies suggest (although not conclusively), a reduction in fall incidents.
This is a relevant article that I can share with my nurses on the importance of medication review and reconciliation.
All clinicians know that medication reviews are essential. This is particularly pertinent for older people. These reviews often identify opportunities to reduce medications and also to recognise actual or potential drug-related issues. The review shows that medication reviews also increase adherence. This can be enhanced by the use of a community pharmacist.
A non-quantitative (principally because of heterogeneity of the intervention, I suppose) systematic review suggests that medication reviews by pharmacists are helpful, which isn`t startling news. This doesn`t, however, answer the question about whether these are better than medication reviews by the patients` managing clinicians.
Only 5 RCTs (the only design that can provide sufficient bias reduction to be worth considering) with very lukewarm surrogate results. Pharmacists` abilities to assist in patient care are entirely jurisdiction-dependent due to varying levels of training, regulation, and integration with physicians.