Table 1.
Study design, characteristics and outcomes of the included studies.
| Author | Country | Setting | Study design | Aim of the study | No. of patients | Mean age (years) ± SD | Female (%) | Mean no. of Rx meds per patient at baseline ± SD | Mean summated MAI score per patient at baseline ± SD | Mean summated MAI score per patient post-intervention ± SD | Secondary outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Bryant et al. 25 | New Zealand | General practitioner (GP) practices in a primary health care. | Randomised controlled trial (RCT) | The objective was to determine whether involvement of community pharmacists undertaking clinical medication reviews, working with general practitioners, improved medicine-related therapeutic outcomes for patients. | I: 269 C: 229 |
I: 75.9 (range 64–92) C: 74.9 (range 60–91) |
I: 64.7% C: 52.4% |
N/A | I: 5.1 C: 4.5 |
I: 3.1 C: 4.2 |
Change in the number of medicines used: more meds were started in the control group than in the intervention group (p < 0.0001). More dosage reductions and medicine switches in the intervention group than in the control group (p = 0.037). Recommendations implemented: 46% of recommendations were implemented, 16% partially implemented. Quality of life (SF-36): improvement in emotional role (13.4-unit difference, p = 0.024) and social functioning (7.7-unit difference, p = 0.019) for the control group. No other domains changed significantly. |
| Hanlon et al. 26 | United States | A general medicine clinic of a Veterans Affairs (VA) medical centre. | RCT | To evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. | I: 105 C: 103 |
I: 69.7 ± 3.5 C: 69.9 ± 4.1 |
I: 1.9% C: 0.0% |
I: 7.6 ± 2.8 C: 8.2 ± 2.7 |
I: 17.7 ± 6.2 C: 17.6 ± 6.1 |
I: 12.8 ± 7.2 C: 16.7 ± 7.1 (At 12 months) |
Quality of life (SF-36): No significant difference between groups (p = 0.99). Adverse drug event (ADE) (%): no significant difference between groups (p = 0.19). Medication compliance (%): no significant difference between groups (p = 0.88). Medication knowledge (%): no significant difference between groups (p = 0.29). VA prescribed meds: no significant difference between groups (p = 0.83). General healthcare satisfaction: no significant difference between groups (p = 0.70). Pharmacy-related healthcare satisfaction: no significant difference between groups (p = 0.52). |
| Raebel et al. 29 | United States | Kaiser Permanente Colorado (KPCO) Medical offices and pharmacies. |
RCT | To determine whether a computerised tool that alerted pharmacists when patients aged ≥65 years were newly prescribed potentially inappropriate medicines, which was effective in decreasing the proportion of patients dispensed these medications. | I: 29,840 C: 29,840 |
Median age (5th, 95th percentiles) I: 74 (66, 88) C: 74 (66, 88) |
I: 57% C: 57% |
Median (5th, 95th percentiles) I: 7 (1, 17) C: 7 (2, 16) |
N/A | N/A | 1.8% of intervention versus 2.2% of control had newly dispensed PIP (p = 0.002). RRR = 16%, ARR = 0.3%. Dispensing rates differed between groups for amitriptyline (p < 0.001; 37% RRR) and diazepam (p = 0.02; 21% RRR). |
| Richmond et al.28 | England | All general practices in five primary care trusts (PCTs). | Interrupted time series (ITS) and repeated measures studies | To estimate the effectiveness of pharmaceutical care for older people, shared between GPs and community pharmacists in the United Kingdom, relative to usual care. Usual care: patients within each of the five PCTs on a waiting list before they received pharmaceutical care. |
A total of 551 were followed through pharmaceutical care. | 80.4 ± 4.1 | 43.2% | 8.1 ± 3.1 | 23.6 ± 19.5 | N/A | Quality of life (SF-36): Mental score: no. = 742, mean = 47.8, SD = 12.2. Physical score: no. = 742, mean = 33.0, SD =10.4. No. of items on repeat prescription: no. = 760, mean = 7.29, SD = 2.23. Serious adverse events: pharmaceutical care model was not associated with any of the reported serious adverse events. |
| Taylor et al. 27 | United States | Three community-based family medicine clinics. | RCT | The programme’s primary purpose was to determine the effect of pharmaceutical care on the prevention, detection and resolution of drug-related problems in high-risk patients in a rural community. | I: 33 C: 36 |
I: 64.4 ± 13.7 C: 66.7 ± 12.3 |
I: 63.6% C: 72.2% |
I: 6.3 ± 2.2 C: 5.7 ± 1.7 |
Percentage of inappropriate prescriptions according to MAI. | Percentage of inappropriate prescriptions according to MAI. | Quality of life (SF-36): no significant difference between groups. Hospitalisations and emergency department (ED) admissions: fewer hospitalisations (2 vs 11, p = 0.003) and ED visits (4 vs 6, p = 0.044) in the intervention group compared to the control group. Compared to the control group, the intervention group was more likely to have controlled blood pressure (p = 0.001), HbA1C (p = 0.001), LDL cholesterol (p = 0.001) and INRs (p = 0.048). Medication compliance: this score improved in the intervention group but not in the control group (p = 0.115). Medication knowledge: this score improved in the intervention group but decreased in the control group (p = 0.000). |
ARR: absolute risk reduction; C: control; I: intervention; INR: international normalised ratio; ITS: interrupted times series; LDL: low-density lipoprotein; MAI: Medication Appropriateness Index; Meds: medications; N/A: not applicable; No.: numbers; RRR: relative risk reductions; Rx: prescription; SD: standard deviation.