Pharmacist Review of Medicines Following Ambulance-Attended Falls—A Multi-Methods Evaluation of a Quality Improvement Initiative

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1. Improve the resolution of figures in the manuscript with at least 300 dpi.
2. Describe why fall in a residential address and fall in public or patient is a care/nursing home resident be one of the criteria assessing if to include the patients. What are the differences of fall condition being considered.
3. "More than three in every four cases reviewed (77.4%) were considered appropriate referrals by pharmacists, suggesting that ambulance clinicians demonstrated sound clinical judgement in identifying suitable patients."This statement remains open to interpretation, as it involves medical expert knowledge specific to triage decisions. As such, conducting a survey may not yield meaningful insights and could lead to ambiguous or inconclusive interpretations.
4. Considering the limitation in line 415, how the authors justify the confidence level of the data and analysis of the manuscript?
5. The experimental setup is somewhat vaguely described, and the specific contribution of polypharmacy to the reported findings remains unclear and may be subject to further scrutiny.

Author Response

Please see the letter submitted under 'reply to academic editors' to view a point by point response to the reviewer comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The study adopts a mixed-methods approach, combining service evaluation and stakeholder surveys, and adheres to SQUIRE and CROSS reporting guidelines. Among patients who received a medicine review, 77.4% were deemed appropriate referrals by pharmacists, indicating sound clinical judgment by ambulance staff. Although the total number of medications remained unchanged, 122 patients had medications deprescribed, and 149 additional changes were recommended (e.g., dosage, timing, substitutions). 85.6% of ambulance professionals rated the referral pathway as “important” or “very important,” showing high acceptance of the intervention. The findings offer valuable guidance for expanding pharmacist involvement in acute care, especially in managing polypharmacy and fall risks.

Of the 775 patients referred, only 340 (43.9%) received a medicine review. Most non-reviewed cases lacked documented reasons. In 62.6% of pharmacist review records, the fall risk level of medications was not documented, limiting analytical depth. The survey response rate was only 22%, and some patients were unaware they had undergone a medicine review, indicating gaps in communication and informed consent.

Author Response

Please see the letter submitted under 'reply to academic editors' to view a point by point response to the reviewer comments.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

1. This is not a research study and appears like a service initiative that does not meet the scope and aims of the journal.
2. The data is more than 5 years old and its unclear why the authors did not report the findings earlier? Much has changed in the past 5 years with reference to the COVID pandemic, the finings are not even relevant not.
3. The data is scattered and not well presented. The first item in the results should be a description of the population in detail (e.g. age, race, gender, etc.....) this has not been done.
4. pls consult a statistician to help run advanced statistics to show what was accomplished (E,g. multi variable or other types of analysis)
5. The way the measures were designed and used, there are a lot of questions on validity, reliability, and other psychometric properties. This content appears arbitrary without much thought or development processes. 
6. The response rates are so low that there is hardly any external validity or generalizbility for the findings to be useful to any other population.
7. The discussion is scattered and runs like a thesis without much focus, direction, implications, interpretations, etc
8. The authors have not acknowledged all the aforementioned limitations and the section also appears superficial.

Comments on the Quality of English Language

Reasonable

Author Response

Please see the letter submitted under 'reply to academic editors' to view a point by point response to the reviewer comments.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The comments are addressed accordingly.

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for the revisions