Table 3.
Summary of studies that involved multidisciplinary team meeting with clinical medication review or studies involving staff education only or staff education with 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 | Other healthcare professionals involved in study | Conclusion |
|---|---|---|---|---|---|---|---|
| Clinical medication review with multidisciplinary team meeting | |||||||
| Wilcher,59 1981 (USA) | Pre–post study, long‐term care facility | 1 | 143 residents from a long‐term care facility | Multidisciplinary team case conference where prevention of chronic pain among residents was discussed | 33 months | Physician, nurse | Pain management case conference with pharmacists improved the judicious use nonopioid pharmacotherapy such as paracetamol and other anti‐inflammatory agents. |
| Cooper,60 1985 (USA) | Pre–post study, long‐term care facility | 1 | 72 residents from a long‐term care facility | Pharmacist‐led medication review with case conference with physician | 48 months | Physician, nurse | Case conferencing reduced the number of drugs used by almost half, reduced admission rates as well as mortality rates. |
| Schmidt,61 1998 (Sweden) | Randomised controlled study, nursing home | Not mentioned, but usually 1 pharmacist per site | 1854 residents in 33 nursing homes (15 homes: 626 in intervention; 18 homes: 1228 in control group) | Multidisciplinary team‐care medication management | 12 months | Physician, nurse, licensed practical nurse and nurse aide | Intervention by multidisciplinary team effectively improved prescribing practice, increase staff knowledge and improve quality of care in nursing home. In particular, the prescribing pattern of antipsychotic drugs improved. |
| Eide,62 2001 (Norway) | Case–control study, nursing home | 1 pharmacist and 1 clinical pharmacologist | 467 residents in 5 nursing homes (388 in intervention and 79 in control group) | Pharmacist‐led medication review on hypnotic drug use followed by case conferencing | Not reported | Physician, nurse | The intervention significantly influenced the quality of use of hypnotics and there was marked reduction in prescribing of benzodiazepines. |
| King,63 2001 (Australia) | Case–control study, nursing home | 1 | 75 residents from 3 nursing homes. | Multidisciplinary team case conference for 30 minutes followed by development of case management plan | 8 months | General practitioner, nursing staffs, physiotherapist | A reduction in the number of medication orders and total cost of medications was noted, with an adjusted mortality data of 6% in the reviewed residents compared to 15% of those who were not reviewed. |
| Midlov,49 2002 (Sweden) | Randomised controlled study, nursing home | 5 | 157 residents from 48 nursing homes (92 in intervention and 66 in control) | Weekly multidisciplinary team medication review | 6 months | Physician, neurologist, neuropsychiatrist, clinical pharmacologist | Poor drug use and documentation of indications in geriatric nursing‐home patients, with 2 in every 5 drugs deemed inappropriate. However, no significant differences were noted in the SF‐36 ‐ 36 Item Short Form SurveyADL ‐ Activities of daily livingbehave‐AD ‐ Behavorial Pathology in Alzheimer's Disease for epilepsy patients. |
| Christensen,50 2004 (USA) | Pre–post study, nursing home | 110 | 9208 residents in 253 nursing homes. | Pharmacist‐led medication review targeted at residents receiving ≥18 prescription refill within 90 d in consultation with prescribing physicians | 6 months | Physician | Reduction of polypharmacy and a reduction of drug costs as well as maintenance or enhancement of the quality of pharmaceuticals was seen |
| Crotty,54 2004a (Australia) | Cluster randomised–controlled study, residential aged care | 1 | 154 residents from 10 high level aged care facilities (100 in intervention and 54 in control) | Multidisciplinary case conference with medication review | 3 months | General practitioner, geriatrician, residential care staff, representative from Alzheimer's association | Improvement in the medication appropriateness especially benzodiazepine use. This did not result in any deterioration of resident behaviour. |
| Crotty, 2004c (Australia) | Randomised single blind study, long‐term care facility | Not reported | 110 residents in 85 long‐term care facility (56 in intervention and 54 in control) | Pharmacist‐led coordination of care transition from hospital to long‐term care facility which included a medication review and case conferencing | 1.5 months | Physician | Use of a pharmacist as a care coordinator was a feasible and simple option to reduce inappropriate medication use and improved quality of prescribing. |
| Lapane,51 2006 (USA) | Pre–post study, nursing homes | Consultant pharmacists and dispensing pharmacists | 4272 residents in 12 nursing homes | Fleetwood model of care comprising of medication review, communication with prescriber and formalised pharmacotherapy plan | 12 months | Prescriber | Most common issues identified were missing information/clarification needed, drug–age precautions, excessive duration alert, suboptimal regimen and need for additional laboratory test. Extending the role of the dispensing and consultant pharmacists beyond federally mandated drug regimen reviews is feasible, although ability to bill and be reimbursed for such services may ensure consistent prospective intervention. |
| Finkers,64 2007 (Netherlands) | Pre–post study, nursing home | 3 | 105 residents | Pharmacist‐ and nursing home physician‐led medication review with case conferencing | 8 months | Physician | The majority of patients had at least 1 drug prescribed for which the indication was unknown. Intervention decreased the number of drugs per patient, but half of the drug‐related problems remained unsolved. |
| Stuijt,53 2008 (Netherlands) | Pre–post study, residential home | 14 | 30 residents from 1 residential nursing home | Pharmacist‐led medication review followed by case conferencing with multidisciplinary healthcare team | 12 months | General practitioner, a member of nursing home | Integration of a clinical pharmacists into the healthcare team improved prescribing appropriateness as well as quality of prescribing. |
| Halvorsen,65 2010 (Norway) | Pre–post study, nursing home | 3 | 142 residents in 3 nursing homes | Pharmacist‐led medication review using established Norwegian classification tool, identification of drug related problem followed by weekly multidisciplinary case conferencing | Not reported | Physician, nurse | The multidisciplinary team intervention was suitable to identify and resolve drug‐related problems in nursing home settings, suggesting further involvement of pharmacists in clinical teams to achieve and maintain high‐quality drug therapy. |
| Patterson,66 2010 (Northern Irelend) | Cluster randomised controlled study, nursing home | 9 | 334 residents in 22 nursing homes (11 homes, 173 intervention and 11 homes, 161 in control) | Fleetwood model of care comprising of medication review, communication with prescriber and formalised pharmacotherapy plan | 12 months | Nurse, resident, carer/relative, general practitioner and other primary care team as needed | Using an adapted US model of pharmaceutical care focusing on inappropriate psychoactive medication, there was marked reductions in inappropriate drug use, but no effect on falls. This model was found to be more cost‐effective than usual care. |
| Brulhart,67 2011 (Switzerland) | Pre–post study, nursing home | 2 | 10 nursing homes | Pharmacist‐led medication review followed by multidisciplinary case conferencing | 24 months | Physician, geriatrician, nurse | There was a need to improve the use of medicines in terms of timing of administration and dosage, choice of appropriate drugs and drug–drug interactions follow up. These drugs were mainly related to alimentary tract and metabolism, nervous system, and cardiovascular system. |
| Davidsson,68 2011 (Norway) | Pre–post study, nursing home | 1 | 93 residents in 1 nursing home | Systematic comprehensive medication review by multidisciplinary team | 15 months | Physician, nurse | Medication reviews conducted by multidisciplinary teams were effective to improve the quality of drug treatment, significantly reducing both number of drugs and number of drug related problems. |
| Baqir,69 2014 (England) | Pre–post study, nursing home | Not mentioned | 422 residents in 20 care homes | Pharmacist‐led medication review with case discussion among a multidisciplinary team | 12 months | General practitioner, nurse | The multidisciplinary medication review could safely reduce inappropriate medication in elderly care home residents and could potentially save up to £77 703 in the study. |
| Staff education with/without clinical medication review | |||||||
| Elzarian,70 1980 (USA) | Pre–post study, long‐term care hospital | Not reported | 87 residents from 1 long‐term care hospital | Educational intervention to nurses to educate on laxative utilisation and pharmacist‐led medication review | 9 months | Physician, nurse | Significant decrease in laxative prescribing and administration especially for the bulk forming, lubricant and saline drug‐class, with substantial costs savings. |
| Avorn,56 1992 (USA) | Randomised controlled study, nursing home | 1 | 823 residents from 12 nursing homes (431 in intervention group and 329 in control group) | Comprehensive educational outreach programme to physician on geriatric psychopharmacology | 2 months | Physician, nurse, nursing assistant | Educational outreach improved the use of psychoactive drugs as well as reduced the use of long‐term benzodiazepines and antihistamine hypnotics. However, some deterioration in cognitive function and anxiety was noted in the intervention group. |
| Roberts,71 2001 (Australia) | Cluster randomised controlled study, nursing home | Not mentioned | 3230 residents in 52 nursing homes (13 homes: 905 intervention; 39 homes: 2325 in 39 control) | Problem‐based educational programme (6–9 seminars totalling 11 hours) on basic geriatric pharmacology, long‐term care such as depression, delirium, dementia, incontinence, sleep disorder, pain, falls to nurses and pharmacist‐led medication review | 12 months | Nurses | Reduction in drug use with no change in morbidity indices or survival. The use of benzodiazepines, nonsteroidal anti‐inflammatory drugs, laxatives, histamine H2‐receptor antagonists and antacids was significantly reduced in the intervention group. |
| Lau,72 2003 (Hong Kong) | Pre–post study, old age homes | Outreach pharmacists (no mention of how many) | 85 homes | Pharmacist‐led medication review with educational talks to staff at old age home on medications use | 8 months | Staffs at old age home | There were issues in the drug management system of nursing homes. These can be classified as in issues related to storage drug administration system, documentation and drug knowledge among staffs. These issues could be easily resolved through the introduction of a pharmacist. |
| Crotty,73 2004b (Australia) | Cluster randomised controlled study, nursing homes and hostels | 1 | 715 residents in 20 facilities (381 in intervention and 334 in control) | Multifaceted intervention incorporating audit, feedback and education to physicians and nurses on falls prevention, use of aspirin in stroke, monitoring of hypertension, risk of psychotropic drugs and benefits of using warfarin in residents with atrial fibrillation | 7 months | Physician, nurse | Intervention did not significantly improve fall rates, psychotropic drug use or when necessary antipsychotics. |