Article date: January 2014
By: Ernieda Hatah, Rhiannon Braund, June Tordoff, Stephen B. Duffull, in Volume 77, Issue 1, pages 102-115
Aim
The aim was to examine the impact of fee‐for‐service pharmacist‐led medication review on patient outcomes and quantify this according to the type of review undertaken, e.g. adherence support and clinical medication review.
Methods
Relevant published studies were identified from Medline, Embase and International Pharmaceutical Abstract databases (from inception to February 2011). Study inclusion criteria were fee‐for‐service medication review, presence of a control group and pre‐specified patient outcomes. Outcomes were grouped into primary (changes in biomarkers, hospitalization, and mortality) and secondary outcomes (medication adherence, economic implications and quality of life). Meta‐analyses for primary outcomes were conducted using random effects models and secondary outcomes were summarized using descriptive statistics.
Results
Of the 135 relevant articles located, 21 studies met the inclusion criteria for primary outcomes and 32 for secondary outcomes. Significant results favouring pharmacists' intervention were found for blood pressure (OR 3.50, 95% CI 1.58, 7.75, P = 0.002) and low density lipoprotein (OR 2.35, 95% CI 1.17, 4.72, P = 0.02). Outcomes on hospitalization (OR 0.69, 95% CI 0.39, 1.21, P = 0.19) and mortality (OR 1.50, 95% CI 0.65 to 3.46, P = 0.34) indicated no differences between the groups. On subgroup analysis, clinical medication review (OR 0.46, 95% CI 0.26, 0.83, P = 0.01) but not adherence support review (OR 0.88, 95% CI 0.59, 1.32, P = 0.54) reduced hospitalization.
Conclusions
The majority of the studies (57.9%) showed improvement in medication adherence. Fee‐for‐service pharmacist‐led medication reviews showed positive benefits on patient outcomes. Interventions that include a clinical review had a significant impact on patient outcomes by attainment of target clinical biomarkers and reduced hospitalization.
DOI: 10.1111/bcp.12140
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