Community Pharmacists' Contribution to Medication Reviews for Older Adults: A Systematic Review : Community Pharmacists and Medication Reviews

regular medication review has been recommended for those over 75 and those on multiple drug therapy. Pharmacists are a potential source of assistance in reviewing medication. Evidence of the benefits of this process is needed. to study the effect of medication review led by a pharmacist on resolution of pharmaceutical care issues, medicine costs, use of health and social services and health-related quality of life. randomized, controlled trial. general medical practices in the Grampian region of Scotland. patients aged at least 65 years, with at least two chronic disease states who were taking at least four prescribed medicines regularly. pharmacists reviewed the drug therapy of 332 patients, using information obtained from the practice computer, medical records and patient interviews. In 168 patients, a pharmaceutical care plan was then drawn up and implemented. The 164 control patients continued to receive normal care. All outcome measures were assessed at baseline and after 3 months. all patients had at least two pharmaceutical care issues at baseline. Half of these were identified from the prescription record, the rest from notes and patient interview. Of all the issues, 21% were resolved by information found in notes and 8.5% by patient interview. General practitioners agreed with 96% of all care issues documented on the care plans in the intervention group. At the time of follow-up, 70% of the remaining care issues had been resolved in the intervention group, while only 14% had been resolved in the control group. There were no changes in medicine costs or health-related quality of life in either group. There were small increases in contacts with health-care professionals and slightly fewer hospital admissions among the intervention group than the control group. pharmacist-led medication review has the capacity to identify and resolve pharmaceutical care issues and may have some impact on the use of other health services.

prescribing for older people is a complex process and can elevate the risk of inappropriate prescribing, with potentially severe consequences. With a growing ageing population, strategies to improve prescribing in care homes are essential. Our aim was to review systematically the effects of interventions to optimise prescribing in care homes. databases searched were MEDLINE, EMBASE, International Pharmaceutical Abstracts and the Cochrane Library from 1990. Search terms included were 'nursing home', 'residential home', 'inappropriate prescribing', 'education' and 'intervention'. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. the search strategy retrieved 16 studies that met the inclusion criteria. Four intervention strategies were identified: staff education, multi-disciplinary team (MDT) meetings, pharmacist medication reviews and computerised clinical decision support systems (CDSSs). Complex educational programmes that focused on improving patients' behavioural management and drug prescribing were the most studied area, with six of eight studies highlighting an improvement in prescribing. Mixed results were found for pharmacist interventions. CDSSs were evaluated in two studies, with one showing a significant improvement in appropriate drug orders. Two of three studies examining MDT meetings found an overall improvement in appropriate prescribing. A meta-analysis could not be performed due to heterogeneity in the outcome measures. results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, education including academic detailing seems to show most promise. A multi-faceted approach and clearer policy guidelines are likely to be required to improve prescribing for these vulnerable patients.