School of Pharmacy, University of Auckland, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
School of Pharmacy, Queen's University, Belfast, Northern Ireland, United Kingdom.
Res Social Adm Pharm. 2019 Dec;15(12):1383-1394. doi: 10.1016/j.sapharm.2019.01.009. Epub 2019 Jan 14.
Pharmacist involvement in medicines reviews for older adults can improve prescribing and reduce adverse drug reactions. Māori experience poorer health outcomes than non-Māori resulting, in part, from inequitable access to and quality of medicine-related care. Despite international data showing benefit, it is unclear whether pharmacist-led medicines review services can improve outcomes for Māori older adults.
This systematic review aims to describe pharmacist-led medicines review services for community-dwelling adults in New Zealand, assess effectiveness of these interventions and identify their effect on health equity for Māori and older adults.
The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Equity (PRISMA-E 2012). Observational studies were included. The intervention in included studies had to involve a pharmacist, occur in the outpatient setting in New Zealand, and involve review of all medicines for an individual patient. At least one patient-related outcome had to be reported.
The search identified seven observational studies with 542 total participants. Study interventions included adherence-based reviews in community pharmacies and multi-step comprehensive clinical reviews in outpatient haemodialysis units. Medicines reviews identified up to a median of 3 drug-related problems per review. The effect of interventions on medicines adherence and knowledge was not clear. Māori may have been less likely than non-Māori to benefit from improved medicines knowledge as a result of interventions. None of the studies incorporated aspects in study design or delivery to address inequities for Māori.
Further investigation is needed to understand whether the development of culturally safe pharmacist-led medicines review services, responsive to community identified needs, can help to achieve equity in health outcomes for Māori older adults.
药剂师参与老年人药物审查可以改善处方并减少药物不良反应。毛利人比非毛利人健康状况更差，部分原因是获得和接受药物相关护理的机会不平等。尽管国际数据表明这种方法有效，但尚不清楚药师主导的药物审查服务是否可以改善毛利老年人的治疗效果。
本系统评价旨在描述新西兰社区居住的成年人中由药剂师主导的药物审查服务，评估这些干预措施的有效性，并确定其对毛利人和老年人健康公平性的影响。
本研究按照系统评价和荟萃分析报告的首选报告项目 - 公平性（PRISMA-E 2012）进行。纳入观察性研究。纳入研究的干预措施必须涉及药剂师，在新西兰的门诊环境中进行，并且必须审查个体患者的所有药物。必须报告至少一个与患者相关的结果。
搜索确定了七项观察性研究，共纳入 542 名参与者。研究干预措施包括社区药房的基于依从性的审查和门诊血液透析单位的多步骤综合临床审查。药物审查每审查一次可确定多达 3 个药物相关问题。干预措施对药物依从性和知识的影响尚不清楚。毛利人可能不太可能像非毛利人那样从干预措施中获得改善药物知识的好处。没有一项研究在研究设计或实施中纳入了针对毛利人的公平性问题的方面。
需要进一步研究以了解是否可以开发出文化安全的药剂师主导的药物审查服务，以满足社区确定的需求，从而帮助实现毛利老年人健康结果的公平性。
