Table 4.
Summary of Findings table
| The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy | |||
|---|---|---|---|
|
Patients or population: Patients over the age of 65 on five or more medications Settings: Primary care Intervention: Pharmacist integration to optimise medications and improve patient outcomes Comparison: Usual care | |||
| Outcomes | Impact |
Number of participants (Studies) |
Certainty of the evidence (GRADE) |
| Potentially inappropriate prescribing | Ten studies favoured pharmacist integration, eight of which demonstrated signficant changes in favour of the pharmacist integration group |
1486 participants (10 studies) |
⊕⊕⊕Ɵa Moderate |
| Number of medications | Mean difference -0.80 [-1.17, -0.43]. Direction of effect of four of the seven studies favoured pharmacist integration in reducing the number of medications prescribed. Confidence intervals for three studies included zero |
1176 participants (7 studies) |
⊕⊕⊕Ɵa Moderate |
| Health-related quality of life | Unclear effect, the direction of results could not be determined due to the heterogeneity in reported results |
4535 participants (15 studies) |
⊕ƟƟƟa, b, c Very low |
| Adverse drug events | Unclear effect, pharmacist integration tended to reduce the risk of ADEs, two studies reported significant results and two studies did not |
409 participants (4 studies) |
⊕⊕ƟƟa, c Low |
| Mortality | No clear effect on mortality |
327 participants (2 studies) |
⊕⊕ƟƟd Low |
Text highlighted in bold indicate main headings
GRADE Working Group grades of evidence
High = This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different is low
Moderate = This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different is moderate
Low = This research provides some indication of the likely effect. However, the likelihood that it will be substantially different is high
Very low = This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different is very high
a downgrade by one level due to serious concerns relating to risk of bias
b downgrade by one level due to serious concerns relating to inconsistency of results
c downgrade by one level due to serious concerns relating to imprecision of results
d downgrade by two levels due to very serious concerns relating to imprecision of results