Effectiveness of a pharmacist-led medication review programme on medication appropriateness and hospital readmissions among geriatric in-patients in Hong Kong

Abstract

A pharmacist-led medication review programme that was supported by geriatricians significantly reduced the number of inappropriate medications and unplanned hospital readmissions among geriatric in-patients.

Interventions to improve the appropriate use of polypharmacy for older people

“…In all cases, interventions were classified as either delivery arrangements (Basger 2015;Bladh 2011;Bucci 2003;Chiu 2018;Crotty 2004b;Fried 2017;Haag 2016;Koberlein-Neu 2016;Michalek 2014;Milos 2013;Muth 2016;Muth 2018;Olsson 2012;Schmader 2004;Spinewine 2007; Thyrian 2017; Van der Linden 2017), implementation strategies (Franchi 2016;Garcia-Gollarte 2014), or both Clyne 2015;Crotty 2004a;Dalleur 2014;Frankenthal 2014;Gallagher 2011;Hanlon 1996;Pitkala 2014;Tamblyn 2003;Taylor 2003;Trygstad 2005;Trygstad 2009; Wehling 2016) (see Types of interventions for definitions).…”

“…Pharmaceutical care was commonly provided by pharmacists working closely with other healthcare professionals in a variety of settings. In hospital settings, pharmacists worked as part of a multi-disciplinary team in outpatient clinics (Bucci 2003;Hanlon 1996;Schmader 2004), in inpatient services on hospital wards as a clinical pharmacy service (Basger 2015;Bladh 2011;Chiu 2018;Dalleur 2014;Franchi 2016;Gallagher 2011;Haag 2016;Michalek 2014;Olsson 2012;Spinewine 2007; Van der Linden 2017; Wehling 2016), or as part of the hospital discharge process (Crotty 2004b). In community settings, pharmaceutical care services, including medication reviews, patient interviews and counselling, were provided by different healthcare professionals.…”

“…Models of pharmaceutical care provided in the included studies were complex and variable. In 17 studies, the pharmacist(s) conducted an independent medication review using participant notes (Bladh 2011;Crotty 2004a;Crotty 2004b; Koberlein-Neu 2016; Milos 2013; Van der Linden 2017), together with participants during a faceto-face encounter (Basger 2015;Bucci 2003;Chiu 2018;Frankenthal 2014;Hanlon 1996;Schmader 2004;Spinewine 2007;Tamblyn 2003;Taylor 2003), or during an medication therapy management (MTM) consultation over the telephone (Haag 2016). Following medication reviews, recommendations were discussed with a multi-disciplinary team during case conferences (Crotty 2004a;Crotty 2004b), sent to patient's own GPs or consultants (Basger 2015;Bladh 2011;Frankenthal 2014; Milos 2013; Van der Linden 2017), or discussed with prescribers and followed up by written recommendations (Hanlon 1996) from multi-disciplinary team members at the same outpatient clinic (Bucci 2003), or during inpatient ward rounds (Spinewine 2007).…”

“…The timing of provision of the intervention was variable. Interventions were delivered over a period of time, for example, during the hospital inpatient stay and at discharge (Bladh 2011;Chiu 2018;Franchi 2016;Haag 2016;Michalek 2014;Schmader 2004;Spinewine 2007; Van der Linden 2017), or over several clinic visits and over several months on an ongoing basis (Tamblyn 2003). Interventions were also delivered at the time of an event, for example, following hospital admission (Dalleur 2014;Gallagher 2011), at discharge from hospital (Basger 2015), during attendance at outpatient clinics (Bucci 2003;Hanlon 1996;Schmader 2004;Taylor 2003), at nursing home visits (Crotty 2004a;Trygstad 2005;Trygstad 2009), at hospital discharge to a nursing home (Crotty 2004b), home visit by a nurse (Olsson 2012), or GP visit Clyne 2015;Fried 2017;Muth 2016;Muth 2018).…”

“…Eleven studies measured medication appropriateness (as measured by an implicit tool); the only implicit tool (judgement-based) used was the Medication Appropriateness Index (MAI) (Bucci 2003;Chiu 2018;Crotty 2004a;Crotty 2004b;Gallagher 2011;Hanlon 1996;Muth 2016;Muth 2018;Schmader 2004;Spinewine 2007;Taylor 2003). Six studies reported MAI as a change from baseline and nine studies reported postintervention scores.…”