Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

Abstract

Objective: To systematically review literature reporting processes, impact and outcomes of medication review and reconciliation in Australian residential aged care facilities (RACFs). Methods: PubMed/MEDLINE, EMBASE, CINAHL, Informit Health and grey literature were searched from 1995 to July 2018. Studies reporting outcomes of a stand-alone medication review or reconciliation interventions in Australian RACFs were included. Results: Thirteen studies investigated medication review, eight of which studied Residential Medication Management Reviews (RMMRs). Five studies reported that medication reviews identified an average of 2.7-3.9 medication-related problems (MRPs) per resident. One study reported medication reviews had no impact on quality of life, hospitalisation or mortality, but was not powered to assess these. Three studies reported general practitioners' acceptance of pharmacists' recommendations to resolve MRPs, ranging between 45 and 84%. Conclusions: Medication review may be a useful strategy to identify and prompt resolution of MRPs. However, the impact on clinical and resident-centred outcomes remains unclear. K E Y W O R D Saged care, geriatric medicine, health services, medication review, medication therapy management, pharmacist interventionThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Practice ImpactThis review suggests that RMMRs identify 2.7-3.9 medication-related problems (MRPs) per resident and general practitioners (GPs) accept 45-84% of recommendations to resolve these MRPs. This highlights the value of pharmacists and GPs working together to optimise medication management in this setting.

The dispensing of psychotropic medicines to older people before and after they enter residential aged care

“…However, it is unclear whether every new RACF resident undergoes an RMMR, and it is unlikely that many residents undergo more than one during their stay. Adoption of recommendations arising from RMMRs is variable, but may be facilitated by interdisciplinary communication before and after the review . The impact of an RMMR is also related to the prescribing culture of the RACF; the resident's general practitioner and the RACF managers and staff must value the review for it to lead to changes in psychotropic medication prescribing .…”

Intervention fidelity and process outcomes of medication reviews including post‐discharge follow‐up in older hospitalized patients: Process evaluation of the MedBridge trial

“…10 Two qualitative studies using interviews with patients and carers 11 and healthcare professionals 12 negatively impact effectiveness of the trial's interventions. 11,12 Assessing intervention fidelity, that is the consistency of the performed interventions with the planned interventions, 10 and intermediate process outcomes, like identified discrepancies and DRPs within a CMR, 13 can provide complementary knowledge. This study therefore aimed to assess the intervention fidelity and process outcomes of CMRs including post-discharge follow-up, as part of a process evaluation of the MedBridge trial.…”

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

“…Residents allocated to the comparison arm received usual care. Residents in the intervention and comparison arms were eligible to continue to receive comprehensive residential medication management reviews (RMMRs) conducted by pharmacists in conjunction with GPs [27].…”