Table 2.
Summary of studies that involved clinical medication review
| Author, y (country) | Study design and setting | No of pharmacists involved in the intervention | No of residents and settings | Service provided, duration and frequency | Study period | Conclusion |
|---|---|---|---|---|---|---|
| Cooper,19 1978 (USA) | Pre–post study, skilled nursing facility | Not reported | 142 residents in 1 nursing facility | Pharmacist‐led medication review examining patient's active problems moly, status of therapeutic endpoint, need of and usage of each regularly scheduled or as needed drug | 12 mo | Reduction in number of regularly scheduled drugs per patient by 19.4%, when necessary drugs by 45.9% and total drugs per patient by 33.8% (from 7.22 to 4.78). |
| Miller,20 1980 (USA) | Pre–post study, skilled nursing facility | 3 | 79 residents from 2 skilled nursing facility | Pharmacist‐led medication review | 6 mo | Identification of issues related to disease management, with recommendations made. A total of 33 (71.7%) were accepted by physicians. |
| Strandberg,21 1980 (USA) | Retrospective analysis, long‐term care facilities | Not reported | 404 residents from a skilled nursing facility and intermediate care facility | Pharmacist‐led medication review | 7 y | Over an 8‐y period, there was reduction in number of prescription drugs (42.8%), nonprescription drugs (34.4%) and number of prescription doses (34.6%) consumed by residents, which led to cost savings. |
| Young,22 1981 (USA) | Pre–post study, skilled nursing facility | 2 | 25 residents from a facility | Introduction of a pharmacist‐led medication review | 1 mo | A reduction of total number of drugs and doses was noted, which can be translated to savings of $0.40/patient/d or $1.7 million annually. |
| Garnett,23 1981 (USA) | Pre–post study, extended care facility | 1 | 24 residents from an extended care facility | Pharmacist‐led medication review | 2 mo | Issues pertaining to disease management, dispensing and drugs were the most commonly identified. The high acceptance and implementation rate suggest potential role of a clinical pharmacist to the quality of resident care. |
| Chrymko24 1982, (USA) | Pre–post study, teaching hospital | 1 | 19 of 21 patients from a long‐term care unit of a hospital | Pharmacist‐led medication review | 2 mo | There was a reduction in average number of scheduled medications among residents in nursing home, but this returned to baseline levels at 14 mo follow‐up. |
| Studnicki‐Gizbert,25 1983 (Canada) | Case–control, nursing home | Not reported | 120 residents from 3 homes | Pharmacist‐led medication review | Not reported | Pharmacist medication review led to a modest improvement in the drug usage among nursing home residents, with a total net saving of $720 with employment of a pharmacist. |
| Thompson,26 1984 (USA) | Case–control, nursing home | 2 | 152 residents from 1 nursing home | Pharmacist‐led medication review | 12 mo | There were fewer death in the intervention group, and lower average number of drugs per patients. There is a potential cost savings of $70,000/y per 100 skill nursing facility beds to the healthcare. |
| Pink,27 1985 (USA) | Retrospective study, long‐term care facility | Not reported | 83 residents from a long‐term care facility | Introduction of a clinical pharmacist to conducted mediation review | 24 mo |
Introduction of a consultant pharmacist improved digoxin related therapy and monitoring. |
| Miller,28 1991 (Unites States) | Pre–post study, intermediate care facility | 1 | 58 residents from a skilled nursing facility | Pharmacist‐led medication review with moly unit inspection as well as serving as a drug information resource | Not reported | The pharmacist positively impacted rational drug use, by reducing the average number of drugs taken per patient as well as patient monitoring |
| Laucka,29 1992 (USA) | Pre–post study, nursing home | 1 | All residents from a nursing home | Pharmacist‐led medication review | Not reported | A reduction in number of when necessary and scheduled medicine was noted, resulting in a cost saving of approximately $27 400. |
| Rees,30 1995 (United Kingdom) | Case–control, nursing home | 1 | 160 residents in 9 residential home | Pharmacist‐led medication review | Not reported | There was a poor acceptance rate of the recommendations by physicians suggesting a need for collaboration between general practitioner and pharmacist. |
| Bellingan,31 1996 (South Africa) | Pre–post study, elderly care facility | 1 | 85 residents in an elderly care facility | Pharmacist‐led medication review | Not reported | Intervention reduced the overall incidence of all drug‐related problems and polypharmacy. |
| Deshmukh,32 1996 (United Kingdom) | Pre–post study, nursing home | 1 | 79 residents in 2 nursing homes | Pharmaceutical advisory service to review and amend policy related to medication storage and administration and pharmacist‐led medication review | Not reported | A reduction in number of when necessary drugs, bed sores and residents who reported adverse events was noted. This was coupled with an improvement in the administrative recordings, with a net potential cost saving of $212 000. |
| Elliott,33 1999 (Australia) | Pre–post study, nursing home | 2 | 128 residents in 4 nursing homes | Pharmacist‐led medication review | Not reported | Changes recommended led to an improvement in patient wellbeing and reduced risk of adverse drug events. The review was reported to be useful and benefited residents, with an estimated yearly reduction in medication costs of $59.76 per resident reviewed. |
| Furniss,34 2000 (United Kingdom) | Randomised controlled study, nursing home | 1 | 330 residents from 14 homes (158 in intervention and 172 in control) | Pharmacist‐led medication review with recommendations and follow up | 8 mo | The number of inappropriate drugs prescribed reduced, with a corresponding saving in drug costs. |
| Ulfvarson,35 2003 (Sweden) | Randomised controlled study, nursing home | 1 | 80 residents in 9 nursing homes (43 in intervention and 37 in control) | Pharmacist‐led medication review specialising in clinical pharmacology and cardiology | 3 mo | Drug reviews are of value to reduce the negative effects but limiting to only cardiovascular drugs makes it non cost‐effective. As such, the reviews should involve >1 class of drug. |
| Trygstad,36 2005 (USA) | Pre–post study, long‐term care | 110 | 253 nursing home | Pharmacist‐led medication review targeting individuals with >18 prescription fills within 90 d | 13 mo | Supplemental programme of medication reviews that targeted by high drug utilisation resulted in a reduction in the persistence of potential drug therapy alerts and was cost beneficial. It also resulted in an improvement of health outcomes. |
| Zermansky,37 2006 (United Kingdom) | Randomised controlled study, care homes | 1 | 661 residents in 65 nursing homes (331 in intervention and 330 in control) | Pharmacist‐led medication review | 6 mo | Clinical medication review by a pharmacist identified medicine related problems in approximately 80% of care home residents, requiring intervention in 1 of their prescribed medications. |
| Bruce,38 2007 (United Kingdom) | Pre–post study, care homes | Not reported | 1340 residents in 40 nursing homes | Pharmacist‐led medication review | Not reported | Medication change involving stopping, withdrawing ineffective or no longer appropriate drugs results in a savings of £100 per patient. |
| Nishtala,39 2009 (Australia) | Retrospective analysis, aged care home | 10 | 500 de‐identified RMMR reports from 62 aged‐care homes | Residential medication management reviews performed by accredited clinical pharmacists | ‐ | Residential medication management review reduced prescribing of sedative and anticholinergic drugs in older people, resulting in a significant decrease in the drug burden index score. The most common drugs implicated were related to alimentary, cardiovascular, central nervous system and respiratory system. |
| Gugkaeva,40 2012 (USA) | Pre–post study, long‐term care facility | Not mentioned | 53 residents in a long‐term care facility | Pharmacists led antibiotic stewardship | 3 mo | The inappropriate prescribing of antibiotics is a major problem in nursing homes, and stewardship led to a 50% reduction in inappropriate use. Additional further research is needed to determine if pharmacists can serve as an effective tool for improving antibiotic use in such settings. |
| Verrue,41 2012 (Belgium) | Randomised controlled study, nursing home | 1 | 384 residents in 2 nursing homes (1 home: 230 in intervention; 1 home: 154 in control) | Pharmacist‐led medication review | 6 mo | The study noted that pharmacist‐conducted medication review only modestly improved the appropriateness of prescribing and a significant reduction of the number of Beers drugs. This could be attributed to the low implementation rate of the pharmacist recommendations. |
| Frankenthal,42 2014 (Israel) | Randomised study, chronic care geriatric facility | 1 | 359 residents in 1 chronic care geriatric facility (183 in intervention and 176 in control) | Pharmacist‐led medication review using STOPP/START criteria to identify for inappropriate medications | 12 mo | Implementation of medication review using STOPP/START criteria reduced the number of medications, falls and cost by US$29/participant/mo. |
| Gheewala,43 2014 (Australia) | Retrospective analysis, aged care facility | Not mentioned | 911 residents from aged care facilities | Residential medication management reviews of renally cleared medications performed by accredited clinical pharmacists | 17 mo | Residential medication management reviews significantly reduced drug‐related problems encountered among residents especially among chronic kidney disease individuals. Additional emphasis is needed in this group to monitor for decline in kidney function. |
| McLarin,44 2015 (Australia) | Retrospective analysis | Not mentioned | 814 residents' RMMR report | RMMRs performed by accredited clinical pharmacists | Not reported | Residential medication management reviews were effective in improving the use of anticholinergics and reducing the anticholinergic burden. |
| Chia,45 2015 (Singapore) | Pre–post study, nursing home | 2–3 for each nursing homes during the pre‐setup period, 1 for each nursing home during post‐setup period | 480 residents from 3 nursing homes | Pharmacist‐led medication review | 6 mo | The introduction of clinical pharmacists into nursing home improved the quality of care among residents and was cost saving (SGD 76.69/mo) |
| Nishtala,46 2016 (Australia) | Retrospective study | Not mentioned | 146 residents' RMMR report | RMMRs performed by accredited clinical pharmacists | ‐ | Application of the CHA2DS2‐VASc risk tool could assist medication review pharmacists in optimising antithrombotic therapy in older adults with atrial fibrillation. |
| Gemeli,47 2016 (USA) | Pre–post study, long‐term care facility | Not mentioned | 36 residents from 11 long‐term care facilities | Pharmacist‐led medication review and deprescribing of sedatives/hypnotics | Not reported | The introduction of a pharmacist to conduct chart reviews among long‐term care facilities resident could reduce the use of inappropriate sedative/hypnotic use among elderly population. |
| Lee,48 2017 (Canada) | Pre–post study, residential care | 3 | 28 residents from 1 residential care | Proton‐pump inhibitors drug use review and deprescribing | 8 weeks | There were limited benefits of deprescribing proton pump inhibitors, but tapering can be used to identify the lowest effective dose and may increase patient comfort with deprescribing in older populations. |
RMMR, residential medication management review