Factors affecting the delivery of community pharmacist-led medication reviews: evidence from the MedsCheck annual service in Ontario

Pechlivanoglou, Petros; Abrahamyan, Lusine; MacKeigan, Linda; Consiglio, Giulia P.; Dolovich, Lisa; Li, Ping; Cadarette, Suzanne M.; Rac, Valeria E.; Shin, Jonghyun; Krahn, Murray

doi:10.1186/s12913-016-1888-2

Cited by 23 publications

(16 citation statements)

References 26 publications

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“…4 in Canada, government-funded, community pharmacy-led adherence support services began in Ontario in 2007. 16 Other provinces have since developed adherence support services and several also run funded medication review services.…”

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confidence: 99%

Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care

2017

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INTRODUCTION:Recognition of the need to reduce harm and optimise patient outcomes from the use of medicines is contributing to an evolution of pharmacy practice in primary health care internationally. This evolution is changing community pharmacy and leading to new models of care that enable pharmacist contribution beyond traditional realms. There is little information about the extent of these changes in New Zealand. AIM:The aim of this study was to investigate emerging roles of pharmacists in primary health care. METHODS:A 10-question electronic survey was used to collect quantitative data about location, employment and roles of pharmacists practising in primary health care.RESULTS: There were 467 survey responses. Although most pharmacists are employed by (78%, n = 357/458) and located in (84%, n = 393/467) community pharmacies, small numbers are dispersed widely across the primary health care sector. Of the 7% (n = 31/467) working in general practices, most are employed by Primary Health Organisations or District Health Boards. Limited cognitive pharmacy service provision is evident in the sector overall, but is much greater for pharmacists spending time located within general practices. DISCUSSION:The large proportion of pharmacists practising in community pharmacies emphasises the importance of the Community Pharmacy Services Agreement in facilitating increased cognitive pharmacy service provision to optimise patient outcomes. The small numbers of pharmacists located elsewhere in the primary health care sector suggest there is scope to improve collaboration and integration in these areas. Flexible funding models that promote innovation and support sustainable practice change are key.

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confidence: 99%

Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care

2017

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“…The low rates of MedsCheck (9%) for eligible patients in our study suggests that there may be challenges with current programme implementation 43. In addition, low rates of MedsCheck suggest that recipients may be highly selected 28. We could not distinguish which patients declined to receive a MedsCheck and which were simply not offered the service despite being eligible.…”

Section: Discussionmentioning

confidence: 71%

“…MedsCheck programme documentation did not define ‘chronic medications’, however we adopted a previously used definition (online supplementary eTable 1). 19 28 The 7-day window for the prescription fill was selected to capture medication changes resulting from hospitalisation 29…”

Section: Methodsmentioning

confidence: 99%

“…We included patient, hospital and pharmacy-level variables which were likely to be associated with receipt of MedsCheck or an outcome 28. These included patient demographics, comorbidities, measures of previous healthcare usage (including receipt of MedsCheck in the previous year), hospital and hospitalisation characteristics (including year of discharge).…”

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confidence: 99%

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Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study

et al. 2019

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BackgroundIn-hospital medication review has been linked to improved outcomes after discharge, yet there is little evidence to support the use of community pharmacy-based interventions as part of transitional care.ObjectiveTo determine whether receipt of a postdischarge community pharmacy-based medication reconciliation and adherence review is associated with a reduced risk of death or re-admission.DesignPropensity score-matched cohort study.SettingOntario, CanadaParticipantsPatients over age 66 years discharged home from an acute care hospital from 1 April 2007 to 16 September 2016.ExposureMedsCheck, a publicly funded medication reconciliation and adherence review provided by community pharmacists.Main outcomeThe primary outcome was time to death or re-admission (defined as an emergency department visit or urgent rehospitalisation) up to 30 days. Secondary outcomes were the 30-day count of outpatient physician visits and time to adverse drug event.ResultsMedsCheck recipients had a lower risk of 30-day death or re-admission (23.4% vs 23.9%, HR 0.97, 95% CI 0.95 to 1.00, p=0.02), driven by a decreased risk of death (1.7% vs 2.1%, HR 0.79, 95% CI 0.73 to 0.86) and rehospitalisation (11.0% vs 11.4%, HR 0.96, 95% 0.93–0.99). In a post hoc sensitivity analysis with pharmacy random effects added to the propensity score model, these results were substantially attenuated. There was no significant difference in 30-day return to the emergency department (22.5% vs 22.8%, HR 0.99, 95% CI 0.96 to 1.01) or adverse drug events (1.5% vs 1.5%, HR 1.03, 95% CI 0.94 to 1.12). MedsCheck recipients had more outpatient visits (mean 2.11 vs 2.09, RR 1.01, 95% CI 1.00 to 1.02, p=0.02).Conclusions and relevanceAmong older adults, receipt of a community pharmacy-based medication reconciliation and adherence review was associated with a small reduced risk of short-term death or re-admission. Due to the possibility of unmeasured confounding, experimental studies are needed to clarify the relationship between postdischarge community pharmacy-based medication review and patient outcomes.

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“…And without evidence as to what constitutes an effective, quality service, pharmacists have no guidance as to how to improve their performance. For example, reporting that pharmacists are providing too few medication reviews and are not focusing on quality reviews to the right patients is inappropriate when there is no understanding of what constitutes a quality medication review, which patients can benefit most from this service and what outcomes, if any, are achieved by provision of the service (77,78).…”

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confidence: 99%

Community pharmacists’ quality-of-care metrics

Winslade¹

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Factors affecting the delivery of community pharmacist-led medication reviews: evidence from the MedsCheck annual service in Ontario

Cited by 23 publications

References 26 publications

Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care

Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care

Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study

Community pharmacists’ quality-of-care metrics

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