School of Pharmacy, University of East Anglia, Norwich, England.
School of Health Sciences, University of East Anglia, Norwich, England.
PLoS One. 2024 Sep 6;19(9):e0309729. doi: 10.1371/journal.pone.0309729. eCollection 2024.
Medication reviews aim to support patients who take medicines, and they are often led by pharmacists. There are different types of medication reviews undertaken in various settings. Previous research undertaken in 2015 found mixed evidence that medication reviews in community settings improve clinical outcomes, but further work needs to be undertaken to establish their impact on patient-orientated and economic outcomes.
This scoping review aims to explore the extent and range of systematic reviews of medication reviews conducted by pharmacists, the nature of the intervention, the evidence for effectiveness, and reported research gaps.
Systematic reviews were included irrespective of participants, settings or outcomes and were excluded if pharmacists did not lead the delivery of the included interventions. Data extracted included the design of included studies, population, setting, main results, description of interventions, and future research recommendations.
We identified twenty-four systematic reviews that reported that medication review interventions were diverse, and their nature was often poorly described. Two high-quality reviews reported that there was evidence of no effect on mortality; of these one reported an improvement in medicines-related problems (all studies reported an increase of identified problems), and another a reduction in hospital readmissions (Risk ratio 0.93 [95% CI 0.89, 0.98]). Other lower-quality reviews reported evidence supporting intervention effectiveness for some clinical outcomes (odds ratio: achieving diabetes control = 3.11 95% prediction intervals (PI), 1.48-6.52, achieving blood pressure target = 2.73, 95% PI, 1.05-7.083.50).
There is mixed evidence of effectiveness for medication reviews across settings and patient populations. There is limited data about the implementation of medication reviews, therefore is difficult to ascertain which components of the intervention lead to improved outcomes. As medication reviews are widely implemented in practice, further research should explore the nature of the interventions, linking the components of these to outcomes.
药物审查旨在为服用药物的患者提供支持，通常由药剂师主导。在不同的环境中进行了不同类型的药物审查。2015 年进行的先前研究发现，药物审查在社区环境中改善临床结果的证据存在差异，但需要进一步开展工作以确定其对患者为导向和经济结果的影响。
本范围界定审查旨在探讨药剂师进行的药物审查系统评价的广度和范围、干预措施的性质、有效性证据以及报告的研究差距。
系统评价无论参与者、环境或结果如何均被纳入，但如果药剂师没有领导纳入干预措施的实施，则将其排除在外。提取的数据包括纳入研究的设计、人群、环境、主要结果、干预措施描述以及未来研究建议。
我们确定了 24 项系统评价，这些评价报告称药物审查干预措施多种多样，其性质往往描述不佳。两项高质量评价报告称没有死亡影响的证据；其中一项报告称药物相关问题有所改善（所有研究均报告发现问题的数量有所增加），另一项报告称减少了住院再入院（风险比 0.93 [95%置信区间 0.89,0.98]）。其他质量较低的评价报告了支持某些临床结果干预有效性的证据（比值比：达到糖尿病控制=3.11 95%预测区间（PI），1.48-6.52，达到血压目标=2.73，95%PI，1.05-7.083.50）。
在不同的环境和患者群体中，药物审查的有效性证据存在差异。关于药物审查实施的数据有限，因此难以确定干预措施的哪些组成部分导致了更好的结果。由于药物审查在实践中广泛实施，因此应进一步研究探索干预措施的性质，将这些组成部分与结果联系起来。
