Community Pharmacists' Contribution to Medication Reviews for Older Adults: A Systematic Review

Kallio, Sonja; Kiiski, Annika; Airaksinen, Marja; Mäntylä, Antti; Kumpusalo-Vauhkonen, Anne; Järvensivu, Timo; Pohjanoksa-Mäntylä, Marika

doi:10.1111/jgs.15416

Cited by 43 publications

(54 citation statements)

References 25 publications

(253 reference statements)

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“…However, there is also evidence of significant variation in the range of activities already undertaken by pharmacists in carrying out this work, from simply providing a record of medications dispensed, to more collaborative interventions that directly engage with and support older people and practitioners with complex medication management. 151 Community pharmacists could be more involved in medication review interventions for older adults, with their contribution extending from identification of DRPs (drug related problems) to a more holistic contribution to medication therapy management. Kallio et al 151 Interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).…”

Section: Practitioner Experience and Expertisementioning

confidence: 99%

“…151 Community pharmacists could be more involved in medication review interventions for older adults, with their contribution extending from identification of DRPs (drug related problems) to a more holistic contribution to medication therapy management. Kallio et al 151 Interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge). Ryan et al 111 Important role of pharmacists in taking accurate medication history across various hospital transitions.…”

Section: Practitioner Experience and Expertisementioning

confidence: 99%

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Medication management in older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Health Serv Deliv Res

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Background The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting The setting was in the community. Participants Older people, informal carers, and health and care practitioners. Interventions Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Main outcome measures Not applicable. Data sources MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners. Study registration This study is registered as PROSPERO CRD42016043506. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 26. See the NIHR Journals Library website for further project information.

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Section: Practitioner Experience and Expertisementioning

confidence: 99%

Section: Practitioner Experience and Expertisementioning

confidence: 99%

Medication management in older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Health Serv Deliv Res

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“…Even though community pharmacists contribute to medication risk management in many ways, little is known regarding what risk management actions they actually take as part of routine dispensing [12][13][14]. Our recent systematic review indicated that medication review interventions involving community pharmacists could reduce medication-related risks and increase adherence in older adults [15]. The same systematic review also concluded that community pharmacists could contribute more to patient care than is currently the case, and more evidence should be available on the impact of the interventions of community pharmacists on medication risk management.…”

Section: Introductionmentioning

confidence: 99%

Medication Risk Management in Routine Dispensing in Community Pharmacies

Kallio

Eskola

Pohjanoksa-Mäntylä

et al. 2020

IJERPH

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Community pharmacists have a duty to contribute to medication risk management in outpatient care. This study aimed to investigate the actions taken by pharmacists in routine dispensing to manage medication risks. The study was conducted as a national cross-sectional online survey targeted at all community pharmacies in Finland (n = 576) in October 2015. One pharmacist from each pharmacy was recommended to be the spokesperson for the outlet to describe their practices. Responses were received from 169 pharmacies (response rate of 29%). Pharmacists were oriented to solving poor adherence and technical problems in prescriptions, whereas responsibility for therapeutic risks was transferred to the patient to resolve them with the physician. Pharmacists have access to a wide range of electronic medication risk management tools, but they are rarely utilized in daily dispensing. Attention was paid to drug–drug interactions and the frequency of dispensing with regard to high-risk medicines. Pharmacies rarely had local agreements with other healthcare providers to solve medication-related risks. In routine dispensing, more attention needs to be given to the identification and solving of therapeutic risks in medications, especially those of older adults. Better participation of community pharmacists in medication risk management requires stronger integration and an explicit mandate to solve the therapeutic risks.

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“…Community pharmacists have been shown to support medication reconciliation and adherence, which can improve chronic disease management. [20][21][22][23][24] Retinal screening in people with diabetes can be done using remote technology at an optometrist's office, with data being analysed off-site by trained ophthalmologists. 25 Technology, including wearable devices like portable oxygen saturation monitors and home blood pressure monitors that connect to electronic medical records, may also partially fill in portions of the clinical exam.…”

Section: Challenges To Making Virtual Care the Central Solutionmentioning

confidence: 99%