Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Abstract

Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.

Evaluation of drug‐related problems and subsequent clinical pharmacists’ interventions at a Swiss university hospital

“…Nevertheless, the clinical relevance of PIs in the hospital setting has also been demonstrated in other countries . This is in line with the findings of several intervention studies suggesting that clinical pharmacy services can reduce the length of hospital stay, the number of adverse drug events and drug‐related readmissions …”

“…By detecting DRPs and intervening appropriately, clinical pharmacists play an increasingly important role in improving the effectiveness and safety of pharmacotherapy. Several studies assessing the impact of clinical pharmacy services in the hospital setting suggest that pharmacists’ interventions (PIs) may have a positive effect on patient‐relevant outcomes such as a shortened length of hospital stay and a reduced number of adverse drug events and drug‐related readmissions . Moreover, PIs have proven to provide cost savings …”

Impact of a Multifaceted Pharmacist-Led Intervention on Antimicrobial Stewardship in a Gastroenterology Ward: A Segmented Regression Analysis

“…Moreover, these habits were not easily changed (Furst et al, 2015), whereby multifaceted interventions with activities at a variety of levels were the most successful in reducing antibiotic prescriptions (Arnold and Straus, 2005;van der Meer and Grol, 2007). Pharmacist-driven ASPs could positively influence doctors' prescribing behavior and perceptions of antibiotic use (Ansari et al, 2003;Shen et al, 2011;Magedanz et al, 2012). This MPL intervention in the GW reaffirmed the need and urgency to expand the involvement of clinical pharmacists in ASPs.…”

“…Thirdly, a declining level in the ALoS was observed. Some studies found that the ALOS was shorted after the intervention of a clinical pharmacist (Shen et al, 2011), while some studies indicated that the intervention had no effect on the ALoS (Bedini et al, 2016;Wenzler et al, 2017), which may be related to differences in the study design and analytical methods. Changes in prescription behavior require multifaceted interventions.…”

A Collaborative Medication Review Including Deprescribing for Older Patients in an Emergency Department: A Longitudinal Feasibility Study

“…Many medication review tools have been developed to identify PIMs in older patients, such as the validated Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria [15]. However, there is contradictory evidence regarding the efficacy of medication reviews for older patients in the ED [16][17][18][19][20]. While studies with collaboration between pharmacists and physicians in multidisciplinary teams on wards have been shown to significantly decrease prescribing inappropriateness in older patients across sectors [21][22][23], this approach has never been tested in an ED.…”