Abstract
Introduction: Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners. Pharmacists may improve management and outcomes for patients with polypharmacy. This systematic review aims to examine the clinical and cost-effectiveness of pharmacist interventions to optimise prescribing and improve health outcomes in patients with polypharmacy in primary care settings. Methods: The review will be reported using the PRISMA guidelines. A comprehensive search of 10 databases from inception to present, with no language restrictions will be conducted. Studies will be included where they evaluate the clinical or cost-effectiveness of a clinical pharmacist in primary care on potentially inappropriate prescriptions using validated indicators and number of medicines. Secondary outcomes will include health related quality of life measures, health service utilisation, clinical outcomes and data relating to cost effectiveness. Randomised controlled trials, non-randomised controlled trials, controlled before-after, interrupted-time-series and health economic studies will be eligible for inclusion. Titles, abstracts and full texts will be screened forinclusionby two reviewers. Data will be extracted using a standard form. Risk of bias in all included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria. Economic studies will be assessed using the Consensus Health Economic Criteria (CHEC) list as per the Cochrane Handbook for critical appraisal of methodological quality. A narrative synthesis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Where data support quantitative synthesis, a meta-analysis will be performed. Discussion: This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group. This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity. PROSPERO Registration: CRD42019139679(28/08/19).
Highlights
Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners
This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group
This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity
Summary
The systematic review will be conducted in line with the PRISMA guidelines. The protocol will be reported in line with the PRISMA-P guidelines. Clinical pharmacists participating in the intervention must be involved in medicines optimisation roles and integrated physically or remotely as per the definition below, within the primary care setting. To be eligible for inclusion, studies must involve a clinical pharmacist optimising medication for patients in a primary care setting through a variety of services. Data extraction Two reviewers (AC and OJ) will use a standardised, pre-piloted form (see extended data26) to perform data extraction of the following information: name of first author, year of publication, country of publication, study setting; study population and participant demographics, intervention details and design, control setting details, recruitment and study completion rates, outcomes and times of measurement. Economic evaluation data will be extracted as per the Health Information and Quality Authority (HIQA) guidelines for interpretation of economic evaluations in Ireland;
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