Pharmacist-participated medication review in different practice settings: Service or intervention? An overview of systematic reviews

Silva, Rafaella de Oliveira Santos; Macêdo, Luana Andrade; Júnior, Genival Araújo dos Santos; Aguiar, Patrícia Melo; Júnior, Divaldo Pereira de Lyra

doi:10.1371/journal.pone.0210312

Cited by 29 publications

(25 citation statements)

References 88 publications

(252 reference statements)

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“…In another study, a clinical pharmacist spent an average of 52 minutes on each patient’s records [41], while in a long-term care facility in Australia, a pharmacist required 3 hours. [42] In contrast, when using the STOPP-START tool, and taking into account that 31% of our patients had a high number of medications—i.e. 8 or more—the research clinical pharmacist reported that the application of the tool was fairly simple and time-effective (15–17 minutes per patient), and viewed it as a sustainable alternative as compared with the traditional medication review.…”

Section: Discussionmentioning

confidence: 98%

Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study

et al. 2019

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Objectives To provide baseline information on inappropriate prescribing (IP), and to evaluate whether potentially inappropriate medications (PIMs), as defined by STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria, were associated with preventable adverse drug events (ADEs) and/or hospitalization. Methods We prospectively studied older patients (n = 301) admitted to three urban, public-funded hospitals. We scrutinized their medical records and used STOPP-START (Screening Tool to Alert Prescribers to Right Treatment) criteria to determine PIM and potential prescribing omissions (PPO) respectively- together these constitute IP. Prescriptions with PIM(s) were subjected to a pharmacist medication review, aimed at detecting cases of ADE(s). The vetted cases were further assessed by an expert consensus panel to ascertain: i) causality between the ADE and hospitalization, using, the World Health Organization Uppsala Monitoring Centre criteria, and, ii) whether the ADEs were avoidable (using Hallas criteria). Finally, percentages of PIM-associated ADEs that were both preventable and linked to hospitalization were calculated. Results IP prevalence was 58.5% (n = 176). A majority (49.5%, n = 150) had moderate to severe degree of comorbidities (Charlson Comorbidity Index score ≥ 3). Median age was 72 years. Median number of medications was 6 and 30.9% (n = 93) had ≥8 medications. PIM prevalence was 34.9% (117 PIMs, n = 105) and PPO 37.9% (191 PPOs, n = 114). Most PIMs and PPOs involved overuse of aspirin and underuse of both antiplatelets and statins respectively. With every increase in the number of medications prescribed, the likelihood of PIM occurrence increased by 20%, i.e.1.2 fold (OR 1.20, 95% CI: 1.1–1.3). Among the 105 patients with PIMs, 33 ADEs (n = 33); 31 ADEs (n = 31) considered “causal” or “contributory” to hospitalization; 27 ADEs (n = 27) deemed “avoidable” or “potentially avoidable”; and 25 PIM-associated ADEs, preventable, and that induced hospitalization (n = 25), were identified: these equated to prevalence of 31.4%, 29.5%, 25.7%, and 23.8% respectively. The most common ADEs were masked hypoglycemia and gastrointestinal bleed. With every additional PIM prescribed, the odds for ADE occurrence increased by 12 folds (OR 11.8, 95% CI 5.20–25.3). Conclusion The majority of the older patients who were admitted to secondary care for acute illnesses were potentially exposed to IP. Approximately a quarter of the patients were prescribed with PIMs, which were plausibly linked with preventable ADEs that directly caused or contributed to hospitalization.

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Section: Discussionmentioning

confidence: 98%

Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study

et al. 2019

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“…Because each reviewer has its qualities and disadvantages, an integrated multidisciplinary approach seems most desirable. Regardless of the way of medication review, prior research advocates interprofessional collaboration to achieve better clinical and economic outcomes [39]. One possible approach is using the CDSS in preparation of an outpatient visit and then have a (partly) joint geriatricianpharmacist consultation.…”

Section: Joint Medication Reviewmentioning

confidence: 99%

Medication in older patients reviewed multiple ways (MORE) study

et al. 2019

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Background Polypharmacy in older patients can lead to potentially inappropriate prescribing. The risk of the latter calls for effective medication review to ensure proper medication usage and safety. Objective Provide insight on the similarities and differences of medication review done in multiple ways that may lead to future possibilities to optimize medication review. Setting This study was conducted in Zuyderland Medical Centre, the second largest teaching hospital in the Netherlands. Method This descriptive study compares the quantity and content of remarks identified by medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System. The content of remarks is categorized in seven categories of possible pharmacotherapeutic problems: 'indication without medication', 'medication without indication', 'contra-indication/interaction/side-effect', 'dosage problem', 'double medication', 'incorrect medication' and 'therapeutic drug monitoring'. Main outcome measure Number and content of remarks on medication review. Results The Clinical Decision Support System (1.8 ± 0.8 vs. 0.9 ± 0.9, p < 0.001) and outpatient pharmacist (1.8 ± 0.8 vs. 0.9 ± 0.9, p = 0.045) both noted remarks in significantly more categories than the geriatricians. The Clinical Decision Support System provided more remarks on 'double medication', 'dosage problem' and 'contraindication/interaction/side effects' than the geriatrician (p < 0.050), while the geriatrician did on 'medication without indication' (p < 0.001). The Clinical Decision Support System noted significantly more remarks on 'contraindication/interaction/side effects' and 'therapeutic drug monitoring' than the outpatient pharmacist, whereas the outpatient pharmacist reported more on 'indication without medication' and 'medication without indication' than the Clinical Decision Support System (p ≤ 0.007). Conclusion Medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System provides different insights and should be combined to create a more comprehensive report on medication profiles.

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“…1 These MR services are typically part of government-funded programs that are not always designed based on published pharmacist intervention studies linked with improvements to patient outcomes. 2,3 There is evidence regarding the benefits of pharmacist-led MRs, including improvements in chronic disease management, quality of life, patient knowledge and satisfaction, resolution of drug therapy problems and reduced medication costs. [4][5][6][7][8] However, there have been no large multinational randomized, controlled trials measuring the impact of MRs on patient morbidity or mortality, and reviews or syntheses of studies often come to inconclusive results.…”

Section: Introductionmentioning

confidence: 99%

“…A previously published comparison of the standardization or consistency of activities performed by pharmacists during MR in various countries was not identified; however, it is clear that the primary aims of MR programs vary widely around the world. 2,[11][12][13] For example, the British Medicines Use Review (MUR) targets adherence, 14 whereas comprehensive medication management (CMM) in the United States includes an intensive workup of pharmacotherapeutic and patientoriented goals. 15,16 Several different national or regional guidelines on MR have been developed, tailoring MR activities to individual health systems.…”

Section: Introductionmentioning

confidence: 99%