Clinical pharmacist review: A randomised controlled trial

Briggs, Sheridan; Pearce, Robert; Dilworth, Sophie; Higgins, Isabel; Hullick, Carolyn; Attia, John

doi:10.1111/1742-6723.12451

Cited by 33 publications

(34 citation statements)

References 22 publications

(41 reference statements)

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“…The findings in the present study highlight an urgent need to introduce medication reconciliation programmes among community-dwelling elderly population and increase educational initiatives among healthcare practitioners with regards to prescribing issues in older individuals. Approaches which have been shown to reduce adverse drug events and hospitalisation associated with polypharmacy should be considered [76–79]. Polypharmacy was not associated with falls, physical function (measured by ADL and IADL) nor quality of life scores in this study though these associations were significant in the univariate model and a model which did not include comorbidities as a covariate.…”

Section: Discussionmentioning

confidence: 56%

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

et al. 2017

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BackgroundPolypharmacy has been associated with increased morbidity and mortality in the older population.ObjectivesThe aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia.MethodsThis was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models.ResultsA total of 1256 participants were included with a median (interquartile range) age of 69(63–74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation.ConclusionA significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.

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Section: Discussionmentioning

confidence: 56%

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

et al. 2017

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“…)Country and settingMean age (IG), yearsNo. Pts.Description interventionPatient selection criteria for medication reviewHCP involvementR: Medication reviewD: Decision about clinical relevancyPatient Involve-mentNr assess-ments/nr patient contactsAdditionalEducationHCPAge, yearsNr drugsOtherBond [38] (2007)LRB12GB, general practicesNr2014R: PharmacistD: GPNo1Yes< 65 a NoSpecific conditions a Briggs [73] (2015)HRB4AU, tertiary referral hospital82.02015R: Hospital pharmacistD: GPYes1Nr>70 a >5 a Living at home a Britton [51] (1991)HRB3US, general medicine clinicNr760R: Clinical pharmacistD: physician (assistant)No1YesNo> 5NoBurns [32]/Furniss [42] (2000)HRB4GB, nursing homes83.5330R: (study) pharmacistD: multidisciplinary teamNo2NrNoNoLiving in nursing homeGallagher [49] (2011)LRB6GB, tertiary medical centre74.5400R: (research) physician, medical teamD: physicianNo1Nr≥ 65 a NoEmergency admission a Graffen [74] (2004)HRB6AU, general practicesNr402R: PharmacistD: GP and patientYes1Nr> 65 a ≥ 5 a Living independently a ; ≥ 1 of following a : use of predefined risk drugs; > 12 doses per day; > 6 diagnoses; BMI < 22Heselmans [33] (2015)HRB0 b BE, general and specialized hospitals66.6600R: PharmacistD: Ward physicianNo1Nr>15 a <...>…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials

et al. 2017

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BackgroundMedication review is often recommended to optimize medication use. In clinical practice it is mostly operationalized as an intervention without co-interventions during a short term intervention period. However, most systematic reviews also included co-interventions and prolonged medication optimization interventions. Furthermore, most systematic reviews focused on specific patient groups (e.g. polypharmacy, elderly, hospitalized) and/or on specific outcome measures (e.g. hospital admissions and mortality). Therefore, the objective of this study is to assess the effectiveness of medication review as an isolated short-term intervention, irrespective of the patient population and the outcome measures used.MethodsA literature search was performed in MEDLINE, EMBASE and Web of Science from their inception through September 2015. Randomized controlled trials (RCTs) with medication review as isolated short term intervention (<3 months) were included. There were no restrictions with regard to patient characteristics and outcome measures. One reviewer extracted and a second checked data. The risk of bias of studies was evaluated independently by two reviewers. A best evidence synthesis was conducted for every outcome measure used in more than one trial. In case of binary variables a meta-analysis was performed in addition to the best evidence synthesis, to quantify the effect.ResultsThirty-one RCTs were included in this systematic review (55% low risk of bias). A best evidence synthesis was conducted for 22 outcome measures. No effect of medication review was found on clinical outcomes (mortality, hospital admissions/healthcare use, the number of patients falling, physical and cognitive functioning), except a decrease in the number of falls per patient. However, in a sensitivity analysis using a more stringent threshold for risk of bias, the conclusion for the effect on the number of falls changed to inconclusive. Furthermore no effect was found on quality of life and evidence was inconclusive about the effect on economical outcome measures. However, an effect was found on most drug-related problems: medication review resulted in a decrease in the number of drug-related problems, more changes in medication, more drugs with dosage decrease and a greater decrease or smaller increase of the number of drugs.ConclusionsAn isolated medication review during a short term intervention period has an effect on most drug-related outcomes, minimal effect on clinical outcomes and no effect on quality of life. No conclusion can be drawn about the effect on economical outcome measures. Therefore, it should be considered to stop performing cross-sectional medication reviews as standard care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0577-x) contains supplementary material, which is available to authorized users.

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“…More globally, as the frail elderly are the prime target population of a specialist geriatric medical and allied health service, early screening could help identify the people likely to benefit from geriatrician input regardless of their presenting problem Referral to geriatric‐certified pharmacists in ED to support appropriate medication prescribing . In the longitudinal ESTHER study, a strong association between the number of medications being taken and frailty was found, even after adjusting for illness burden and other patient characteristics .…”

Section: Can Thinking About Frailty Help Our Ed Patients?mentioning

confidence: 99%

Frailty, thy name is…

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Burkett

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et al. 2017

Emerg Medicine Australasia

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Clinical pharmacist review: A randomised controlled trial

Abstract: The presence of an experienced pharmacist in the ED reduced hospital admissions. Further study is required to determine longer term impacts of General Medical Practitioner acceptance of pharmacists' recommendations.

Cited by 33 publications

References 22 publications

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials

Frailty, thy name is…

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