Medication Reviews by Clinical Pharmacists at Hospitals Lead to Improved Patient Outcomes: A Systematic Review

Abstract

Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100 interventions were included in the final assessment. A total of 836 research papers were identified, and 31 publications were included in the study: 21 descriptive studies and 10 controlled studies, of which 6 were randomized controlled trials. The pharmacist interventions were well implemented with acceptance rates from 39% to 100%. The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use. Several outcomes were statistically insignificant, but these were predominantly associated with low sample sizes or low acceptance rates. Therefore, future research within this area should be designed using rigorous design, large sample sizes and includes comparable outcome measures for patient health outcomes.Suboptimal medication use may lead to increased morbidity, mortality and costs [1][2][3]. A study among older persons in the ambulatory care setting showed that almost 10% of reported adverse drug events were fatal or life-threatening [1]. A metaanalysis estimated the costs associated with adverse drug events to $10-23 million per 100,000 admissions [2]. Moreover, a recent meta-analysis demonstrated that about half of the adverse drug reactions causing morbidity and resulting in a significant burden to healthcare may be prevented [3].To reduce unnecessary patient harm, medicines management may be provided by clinical pharmacists working in collaboration with other healthcare professionals to optimize medication treatment. As part of this process, pharmacists have a vital role in providing medication reviews with the purpose of identifying medication-related problems and recommending changes to optimize the medical treatment [4]. Medication reviews can be conducted at different levels from prescription review with rapid checks of medication orders, to full clinical medication reviews, where the clinical pharmacist assesses the medical treatment in the context of the patient's conditions and symptoms [5,6]. In the hospital setting, the clinical pharmacist has access to all patient data, can intervie...

Reduction in the use of potentially inappropriate drugs among old people living in geriatric care units between 2007 and 2013

“…Medication reviews by clinical pharmacists have provided promising results among hospitalised patients, with one study for example showing a reduced rate of readmissions, prolonged time to readmissions and a reduction in the length of the hospital stay [23]. There are other examples that have shown reduced rates of drug-related readmissions after the introduction of medication reviews [22,24], and yet, another review showed that medication reviews performed by clinical pharmacists led to improved patient outcomes, such as improved quality of prescribing and reduced costs [40]. There is still a need for more studies, and in particular randomised controlled trials, to evaluate the effects of medication reviews in different patient groups, but it should also not be forgotten that the implementation of medication reviews might have positive indirect effects.…”

Pharmaceutical care in a long-stay psychiatric hospital

“…Pharmacists’ interventions (PIs) are generally highly accepted 28. Graabæk and Kjeldsen28 systematically reviewed the impact of pharmacists’ medication reviews in hospitals.…”

“…Graabæk and Kjeldsen28 systematically reviewed the impact of pharmacists’ medication reviews in hospitals. High acceptance rates (>69%) were reported in 16 out of the 31 included publications (ranging from 39% to 100%).…”

“…In the literature,28 PIs in psychiatric settings have included dose and medication changes as well as laboratory and drug-level monitoring. In our study, the most frequently proposed intervention was discontinuation of medication, mainly as a consequence of the prevailing practice of APP and inappropriate prescribing of benzodiazepines.…”

Pharmacist-led interventions improve quality of medicine-related healthcare service at hospital discharge

“…This corresponds well with the high acceptance rate (84%) and demonstrates high clinical relevance of the pharmacist’s input. Other clinical studies have reported acceptance rates varying from 39% to 100%,11 which supports the importance of clinical pharmacist’s contribution to ensure rational pharmacotherapy. It would have strengthened our results if evaluation from physicians in primary care also had been included, but this was due to practical circumstances not possible.…”