Basheti et al. [16], 2011, Jordan, cross-sectional study, 167 patients, 58.9 yr |
To assess the prevalence of TRPs and their types among chronic disease patients |
HMR by pharmacists. |
Prevalence and nature of TRPs |
The mean number of disease conditions and number of medications per patient were found to be 4.1 ± 1.7 and 8.1 ± 2.7, respectively; The mean number of TRPs identified per patient through the HMR was 7.4 ± 2.8; Among the TRPs identified, 125 (74.9%) were incomplete drug therapy problems, 114 (68.3%) were untreated conditions, 101 (60.5%) were non-adherence to non-pharmacological therapy, 84 (50.3%) were inappropriate dosage regimens, 40 (23.9%) were adverse drug effects, and the fewest were potential drug interactions (n=17; 10.2%) |
The study results demonstrated the integral role of pharmacists in identifying TRPs in Jordanian outpatients with chronic diseases visiting community pharmacies; Furthermore, patients were satisfied and accepted the HMR services offered by their community pharmacists, including the home visit aspect |
Castelino et al. [9], 2009, Australia, retrospective cohort study, 224 patients, 74.65 yr |
To assess the nature and extent of DRPs and the actions recommended by the pharmacists to resolve DRPs |
HMR by pharmacists. |
DRPs |
Patients who were receiving HMR services were prescribed a mean (SD) number of 10.7 (3.8) medications; Pharmacists identified at least 1 DRP in 98% of the patients reviewed; Overall, the pharmacists identified a total of 1,110 DRPs, the most common (16%) being the need for an additional medicine; On average (SD), 4.9 (2.9) problems were identified per patient; Thirty-four percent of all the problems were related to the selection of a specific medicine, 24% to the medication dosing regimen and management issues, and 19% to patients’ knowledge and medication management skills |
The study infers that a well-trained pharmacist with full access to the patients and their medical records and supporting resources could potentially enhance the quality use of medicines among the elderly population; It also suggests that most of the actions recommended by the pharmacists during the HMR process were consistent with the current literature |
Chandrasekar et al. [14], 2017, India, cross-sectional study, 85 patients, 40-59 yr |
To identify, prevent, and resolve potential MROs, optimize pharmacotherapy, and assist in achieving better health outcomes for patients at home |
HMR by pharmacists |
MRPs |
Drug interactions were the main problem found in the majority of the prescriptions; Around 32% of the population experienced ADRs upon taking medications, and 64% of them did not use any over-the-counter drugs; In terms of knowledge gaps, multiple drug storage was the most critical error, while 34% of the patients were not aware of the name of a drug, 27% did not know the reason for taking a drug, and 27% were not aware of individual instructions given during pregnancy |
This study suggested that qualified pharmacists can play a major role in improving the appropriateness of prescribing and preventing medication-related adverse events; Additionally, pharmacists in collaboration with general practitioners can optimize patients’ medications |
Cheen et al. [18], 2016, Singapore, retrospective cohort study, 499 patients, >70 yr |
To determine the impact of a pharmacist-provided HBMR program on readmissions in the elderly population |
HBMR by a pharmacist |
DRPs, readmission rate, ED visits, outpatient visits, and mortality |
A total of 464 DRPs, corresponding to an average of about 5 DRPs per patient, were identified; Pharmacist-provided HBMR reduced readmissions by 26%, reduced ED visits by 20%, and increased outpatient visits by 16%; The most commonly identified DRPs were non-adherence (38.6%), untreated indication (22.4%), and overdosage (9.9%), and the pharmacists had resolved 36.4% of DRPs within 1 month of the home visit |
This study suggested that pharmacist-led HBMR services led to significantly decreased readmissions and emergency visits among the elderly population; However, the mortality benefit was unclear, although there was a trend towards lower mortality among those who received HBMR |
Elliott et al. [10], 2012, Australia, prospective randomized comparative study, 80 patients, 84 yr |
To compare 3 different methods for promoting a pharmacist-led medication review for patients referred to an ACAT and to compare MRPs identified via ACAT usual care with those identified via pharmacist-led medication reviews |
Comprehensive medication review by pharmacists |
MRPs |
Overall, 21 MRPs were identified via ACAT usual care: 5 (23.8%) were classified as high-risk, 10 (47.6%) as moderate-risk, 5 (23.8%) as low-risk, and 1 (4.8%) as insignificant; Pharmacists’ review of the ACAT files (without a pharmacist home visit) identified a further 164 potential MRPs; however, in the 40 patients who received an APHMR, 35 of 82 potential MRPs (42.7%) turned out not to be actual problems once further information was obtained from the patient; The APHMR identified 79 additional MRPs that were not identified from a review of the ACAT files; In total, 122 pharmacist-identified MRPs were included in APHMR reports to patients’ GPs; 94 of these were assessed as being associated with moderate, high, or extreme risk of an adverse event if not addressed |
The study revealed that adding a pharmacist to the usual care assessment teams could significantly help in identifying and resolving MRPs; In addition, it was also inferred that home visits by a pharmacist can serve as a more efficient way for identifying MRPs than a routine medication review of the collected data; Furthermore, adding pharmacists to ACATs may provide a reliable and cost-effective method for delivering medication reviews, which reduce the risk of adverse events |
Fiss et al. [17], 2010, Germany, prospective cohort study, 37 patients, 75.5 yr |
To establish an interdisciplinary health professional network to systematically identify and evaluate DRPs in the patients’ homes, and to provide recommendations |
Community-based HMR |
DDIs |
During a GP–supporting, community-based, e-health assisted, systemic intervention, 56 potential DDIs were identified, and 37 of the 112 drugs which caused potential interactions were attributed to OTC medication and food components; The mean number of drugs recorded per patient was 14.2; The evaluations of clinically relevant potential DDIs yielded relevant DDIs in 44.6% of the patients (n=25) |
The study results suggested that a notable prevalence of DRPs was identified by a comprehensive HMR conducted by GP–supporting, community-based, e-health assisted, systemic intervention practice assistants in cooperation with local pharmacists |
Gheewala et al. [12], 2014, Australia, retrospective cohort study, 847 patients, 84.9 yr |
To investigate the number and nature of DRPs and recommendations made by pharmacists among residents of aged care facilities |
Collaborative RMMR service by pharmacists |
DRPs |
Of the 847 included patients, the mean (SD) number of medications prescribed per resident was 11.2 (4.8); The pharmacists identified a total of 2,712 DRPs in 98% of the residents; The mean (SD) number of DRPs identified per resident was 3.2 (1.7); Of 3,054 recommendations made, 2,560 (83.8%) were accepted by the GP; The mean (SD) number of recommendations made per resident by the pharmacist was 3.6 (1.9) and mean (SD) number of recommendations accepted by the GP per resident was 3.0 (1.9) |
The study suggested that the collaborative RMMR service with the help of an accredited pharmacist could significantly reduce DRPs among the residents of aged care facilities |
Lenander et al. [13], 2018, Sweden, cross-sectional study, 1,720 patients, 87.5 yr |
To evaluate the effect of medication reviews on total medication use and potentially inappropriate drug use among elderly patients, and to describe the occurrence and types of DRPs |
Medication review by clinical pharmacists |
DRPs |
Of the 1,720 patients, 61% of them were on 10 or more drugs (range, 1-35); DRPs were identified in 84% of the patients, and a total of 3,868 DRPs were identified, giving a mean of 2.2 DRPs per patient; The most frequent types of DRPs (n = 3,868) identified were unnecessary drug therapy (39%), the wrong drug (20%), and an excessively high dose of medications (21%); Drug withdrawal was identified as the most common result |
This study inferred that medication reviews performed in daily care by clinical pharmacists are one way to identify DRPs and to improve drug use among elderly patients; It also concluded that drug use is voluminous among elderly patients in home care and nursing home residents, and that additional drug therapy is a common problem |
Nishtala et al. [11], 2009, Australia, retrospective cohort study, 500 patients, 84 yr |
To investigate the number and nature of DRPs identified by accredited clinical pharmacists |
Medication review by accredited clinical pharmacists. |
DRPs |
In a 500 randomly selected, de-identified medication reviews performed by 10 accredited clinical pharmacists over 6 months across 62 aged care homes, a total of 1,433 MRPs were identified in 480 residents; Potential DRPs were classified as a need for additional monitoring, risk of ADRs, and inappropriate choice of a drug; Among identified DRPs, alimentary, cardiovascular, central nervous system and respiratory drugs were most frequently implicated, accounting for more than 75% of the DRPs |
The study concluded that clinical pharmacists have a potential role in identifying DRPs among older people living in aged care homes; Moreover, the recommendations made by pharmacists to minimize the risk of ADRs and to optimize drug choices were accepted and implemented by GPs |
Papastergiou et al. [15], 2013, Canada, cross-sectional study, 43 patients, 77.4 yr |
To identify and resolve the drug therapy problems of homebound patients |
Pharmacist-directed HMR |
Drug-therapy problems |
The patients were taking a mean of 11.7 (range, 3-23) medications; Pharmacists identified a total of 62 drug therapy problems; The top 3 types of problems identified were non-compliance (40.3%), ADRs (20.9%) and additional therapy required (19.4%); Of the seniors, 44% were found to be using at least 1 medication on the Beers criteria list, whereas 7% were using 3 or more; Medications were removed from the homes of 58% of the patients, most commonly due to expiry of medication |
The study concluded that pharmacists are among the most accessible front-line primary care practitioners and can provide care to home-bound patients; Pharmacist-directed HMRs offer an effective mechanism to address pharmacotherapy issues and could serve to minimize the inappropriate use of medication and health care costs |