Abstract
BackgroundMedication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting.Review methodsTo determine the effectiveness of pharmacist home visits for individuals at risk of medication-related problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data.ResultsTwelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I2 = 69.0%, p = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I2 = 0%, p = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge.ConclusionA systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes.
Highlights
Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults
A systematic review of twelve Randomised controlled trial (RCT) assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life
Studies from across Europe have estimated that the proportion of elderly experiencing drug related problems that lead to hospital admission range between 4 and 30% [2]
Summary
Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Medication mismanagement and drug-related problems are a major cause of nursing home placement of frail older adults [1]. In the United Kingdom (UK), the National Service for Older People Framework [4] recommends regular medication reviews for people > 75 yrs. This is to maximise therapeutic benefit and to minimise harm. A ‘Medicines Use Review’, a free National Health Service offered by pharmacies in the UK, was introduced in 2005 [6] Whilst this is not intended to provide a full medication review service, it is intended to improve the patient’s knowledge and use of drugs, as well as identify drug-related problems (DRPs). In the UK home medicine reviews are typically held within the pharmacy and home visits can be made for exceptional cases, they are currently not routine
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