ABSTRACT
Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists' medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients' overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist's medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.
ABSTRACT
BACKGROUND: prescribing for older people is a complex process and can elevate the risk of inappropriate prescribing, with potentially severe consequences. With a growing ageing population, strategies to improve prescribing in care homes are essential. Our aim was to review systematically the effects of interventions to optimise prescribing in care homes. METHOD: databases searched were MEDLINE, EMBASE, International Pharmaceutical Abstracts and the Cochrane Library from 1990. Search terms included were 'nursing home', 'residential home', 'inappropriate prescribing', 'education' and 'intervention'. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. RESULTS: the search strategy retrieved 16 studies that met the inclusion criteria. Four intervention strategies were identified: staff education, multi-disciplinary team (MDT) meetings, pharmacist medication reviews and computerised clinical decision support systems (CDSSs). Complex educational programmes that focused on improving patients' behavioural management and drug prescribing were the most studied area, with six of eight studies highlighting an improvement in prescribing. Mixed results were found for pharmacist interventions. CDSSs were evaluated in two studies, with one showing a significant improvement in appropriate drug orders. Two of three studies examining MDT meetings found an overall improvement in appropriate prescribing. A meta-analysis could not be performed due to heterogeneity in the outcome measures. CONCLUSION: results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, education including academic detailing seems to show most promise. A multi-faceted approach and clearer policy guidelines are likely to be required to improve prescribing for these vulnerable patients.
