Impact of pharmacist-led shared medication reviews on adherence among polymedicated older patients: an observational retrospective French study

Abstract

BackgroundInappropriate medication use or suboptimal medication adherence among polymedicated older patients is a public health concern. To tackle this issue, a pharmacist-led shared medication review (SMR) system was implemented in French community pharmacies in March 2018. SMR is an analysis of the drug treatments of the older patient with multiple medications. SMR takes place in the form of several interviews, at the pharmacy with the pharmacist, in a confidential space. ObjectivesThis observational real-world study evaluated the impact of the SMR service on medication adherence among polymedicated older patients in France. The risk of drug-related iatrogenic events in this population and the extent to which pharmacist SMR recommendations were followed by prescribers were also assessed. MethodsData were collected using the Observia webtool made by Observia society, a purpose-built digital platform distributed nationwide to community pharmacies to facilitate the SMR process. ResultsData were analyzed from 439 patients (aged 65-75 years or older) who had completed their SMR at one of 297 French community pharmacies equipped with the Observia webtool. Overall, 186 patients had suboptimal adherence before SMR; 47% of these patients (n = 88) improved to have good adherence after completing the review. The rate of SMR-recommended prescription changes implemented by prescribers was low (14.7%; 38 of 258), with changes being implemented precisely as recommended in 47.4% of cases (n = 18). Potential iatrogenic events were identified in 20 patients. ConclusionsAlthough the SMR service is in the early stages of implementation in France, this study revealed that the process had a positive impact on medication adherence among older polymedicated patients. However, improvements are needed to reinforce prescriber and patient confidence in the system and further improve health outcomes.