Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Search Strategy
2.3. Study Selection
2.4. Data Extraction
2.5. Risk of Bias (Quality Assessment)
2.6. Data Analysis
3. Results
3.1. Characteristics of Included Studies
3.2. Risk of Bias Assessment
3.3. Types of Community Pharmacists’ Interventions
3.3.1. Medication Review
3.3.2. Educational Intervention
3.3.3. Pharmaceutical Care
3.3.4. Electronic Reminder Device
3.4. The Outcomes of the Interventions
3.4.1. Hospitalization
3.4.2. Sedative–Hypnotics Users
3.4.3. Number of Older Adults Who Fall
3.4.4. Potentially Inappropriate Medications
3.4.5. Medication Adherence
3.4.6. Adverse Drug Events
3.4.7. Other Outcomes
3.5. Sensitivity Analysis
3.6. Subgroup Analysis
3.7. Certainty of Evidence
4. Discussion
4.1. Strengths and Limitation
4.2. Implications for Research and Practice
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author, Year, Country | Study Design, Settings | Interventions | Control Sample Size | Intervention Sample Size | Follow-Up Period | Outcomes | Conclusion |
---|---|---|---|---|---|---|---|
Bryant et al. [28] (2010) New Zealand | Randomized, controlled trial, Community pharmacy | IG: Medication review was completed with the access of medical records from GP. A care plan was prepared, and discussions were completed among CP and GP. Follow-up consultations with patients were completed after taking action on the care plan. CG: Usual care | 143 | 207 | 6 months and 12 months | Quality of Life (SF-36) and Medication Inappropriateness Index (MAI), number of inappropriate medications | Medication review improved MAI and reduced the number of potentially inappropriate medicines at 6 months follow-up. However, this intervention did not produce a significant improvement in quality of life. |
Falamic et al. [29] (2019) Croatia | Randomized, controlled trial, Community pharmacy | IG: Education with follow-up plan (given pillbox and plan form) CG: Standard GP-managed care | 66 | 65 | 6 months | The incidence and type of adverse drug reactions caused by warfarin | The cumulative incidence of adverse drug reactions was significantly lower in the intervention group. |
Mott et al. [30] (2016) United States | Cluster-randomized, controlled trial, Community pharmacy | IG: Medication therapy management with follow-up CG: Received mailed pamphlet describing medication use and falls | 41 | 39 | 6 months | Rate of discontinuing the fall-risk inducing drug | Medication review significantly improved the rate of discontinuation of fall-risk-inducing drugs among older adults and reduced the number of falls. |
Touchette et al. [31] (2012) United States | Randomized, controlled trial, Academic medical center, community pharmacies, and family medicine clinics | IG: Medication therapy management (MTM) with follow-up (enhanced MTM) CG: Usual care | 208 | Basic MTM = 211 Enhanced MTM = 218 | 6 months | Frequency of adverse drug events and hospitalization | Medication review did not have a beneficial impact on adverse drug events and hospitalization. |
Varas–Doval et al. [32] (2020) Spain | Open-label, multi-center, cluster-randomized, controlled trial, Community pharmacy | IG: Medication review with follow-up CG: Usual care | 715 | 688 | 6 months | Uncontrolled health problems | Medication review benefited, with a significant reduction in the number of uncontrolled health problems. |
Olesen et al. [33] (2014) Denmark | Cluster-randomized, controlled trial, Patient’s home | IG: Pharmaceutical care (examining medication list of older adults, answering any questions on their medications, providing leaflets and motivational adherence support) CG: Usual care | 264 | 253 | 3, 6, 9, and 24 months | Medication adherence, hospitalization, and mortality | Pharmaceutical care did not bring a beneficial impact on medication adherence, hospitalization, and mortality among older adults. |
Toivo et al. [34] (2019) Finland | Cluster-randomized, controlled trial, Community pharmacy, homecare units, public health care center | IG: Collaborative coordination of care (medication review and triage meeting) CG: Standard home care | 87 | 104 | 12 months | Potentially inappropriate medication | No significant findings were found on the impact of coordination of care on outcomes of older adults’ health. |
Malet-Larrea et al. [35] (2016) Spain | Cluster-randomized, controlled trial, Community pharmacy | IG: Medication review with follow-up CG: Usual care | 715 | 688 | 6 months | Hospitalization | The probability of being hospitalized was 3.7 times higher in the non-intervention group. Thus, medication review had reduced the number of older adults hospitalized. |
Tannenbaum et al. [36] (2014) Canada | Cluster-randomized, controlled trial. Community pharmacy | IG: Patient education (materials which also contained benzodiazepine safety and tapering dose) CG: Usual care | 155 | 148 | 6 months | Benzodiazepine therapy discontinuation | Patient education improved the benzodiazepine discontinuation rate among older adults. |
Van Der Meer et al. [37] (2018) Netherlands | Single-blind, randomized, controlled trial, Community pharmacy | IG: Medication review with follow-up CG: Usual care | 82 | 75 | 3 months | Drug burden index, hospitalization | Medication review did not have significant effects on the number of falls and hospitalization. Moreover, it did not produce an impact on the difference in drug burden index between groups. |
Martin et al. [38] (2018) Canada | Cluster-randomized, controlled trial, Community pharmacy | IG: Patient education (education materials were distributed), and education materials were given to prescribers CG: Usual care | 241 | 248 | 6 months | Sedative-hypnotics (benzodiazepine therapy discontinuation) and potentially inappropriate medication | Patient education reduced the number of benzodiazepine users and reduced the number of inappropriate medications among older adults. |
Falamic et al. [39] (2018) Croatia | Prospective, double-blind, randomized, controlled trial, Community pharmacy | IG: Education and follow-up plan with medication review (given a form containing lab values, INR, and pillbox. CG: Usual GP care | 66 | 65 | 6 months | Time in therapeutic range of warfarin | Patient education improved time in the therapeutic range of warfarin. |
Outcome | Number of Studies | Number of Participants | Statistical Method | Effect Size 95% (CI) |
---|---|---|---|---|
Hospitalization | 3 [31,35,37] | 1986 | Risk ratio (M–H, random, 95% CI) | 0.74 (0.54,1.00) |
3 months | 2 [31,35] | 583 | Risk ratio (M–H, random, 95% CI) | 0.62 (0.35,1.11) |
6 months | 2 [31,37] | 190 | Risk ratio (M–H, random, 95% CI) | 0.78 (0.50,1.23) |
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Christopher, C.M.; KC, B.; Blebil, A.; Alex, D.; Ibrahim, M.I.M.; Ismail, N.; Alrasheedy, A.A. Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis. Healthcare 2021, 9, 1577. https://doi.org/10.3390/healthcare9111577
Christopher CM, KC B, Blebil A, Alex D, Ibrahim MIM, Ismail N, Alrasheedy AA. Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis. Healthcare. 2021; 9(11):1577. https://doi.org/10.3390/healthcare9111577
Chicago/Turabian StyleChristopher, Christina Malini, Bhuvan KC, Ali Blebil, Deepa Alex, Mohamed Izham Mohamed Ibrahim, Norhasimah Ismail, and Alian A. Alrasheedy. 2021. "Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis" Healthcare 9, no. 11: 1577. https://doi.org/10.3390/healthcare9111577