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The effect of home medication review in community-dwelling older adults: a systematic review

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Abstract

Aim

Home medication reviews (HMR) are designed to address all drug-related problems in a patient’s home setting. However, the impact on the health care system is not known. The objective of our review was to assess the implications of HMR on health care utilization and patient-related outcomes for older adults.

Methods

We searched electronic databases from 1990 to 2019, including Ovid databases, CINAHL, Cochrane Library, health technology assessment and economic evaluation databases, and gray literature. We included prospective, quasi-experimental (including a control group), or randomized controlled trials. Duplicate screening was carried out for eligibility, risk of bias, and data extraction.

Results

We identified 3558 articles, leading to a total of 18 included studies. For the primary outcome of health care utilization, HMR showed a significant reduction in 4 of 12 studies that reported this outcome. However, one study reported increased hospital readmissions in the intervention group. As for mortality, one of 13 studies reported a significant decline in favor of HMR intervention. Similarly, one of seven studies showed an improvement in patient quality of life. Of the five studies reporting adherence, two showed improvement. Two studies showed a reduced number of medications. Overall risk of bias ranged between “unclear” and “high,” and none showed “low” risk.

Conclusion

We found that HMR provides a modest benefit in improving health care utilization and some medication measures. However, the studies were quite variable in how HMR was delivered, and in the outcome measures reported. The magnitude of benefit from HMR appears insufficient to warrant a policy change at this time.

PROSPERO registration

CRD42019126925.

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References

  • Aldamiz-Echevarría Iraúrgui B, Muñiz J, Rodríguez-Fernández J, Vidán-Martínez L, Silva-César M, Lamelo-Alfonsín F et al (2007) Ensayo clínico aleatorizado y controlado para valorar una intervención por una unidad de hospitalización domiciliaria en la reducción de reingresos y muerte en pacientes dados de alta del hospital tras un ingreso por insuficiencia cardiaca. Rev Esp Cardiol 60(9):914–922

    Article  Google Scholar 

  • Begley S, Livingstone C, Hodges N, Williamson V (1997) Impact of domiciliary pharmacy visits on medication management in an elderly population. Int J Pharm Pract 5(3):111–121

    Article  Google Scholar 

  • Boamah SA, Spence Laschinger HK, Wong C, Clarke S (2018) Effect of transformational leadership on job satisfaction and patient safety outcomes. Nurs Outlook 66(2):180–189

    Article  Google Scholar 

  • Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR et al (2019) Decision making for older adults with multiple chronic conditions: executive summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 67(4):665–673

    Article  Google Scholar 

  • Canada P, Health Status of Canadians (2016) Report of the chief public health officer - what is a health indicator? - Canada.Ca [internet]. Canada.Ca. 2019 [cited 22 February 2019]. Available from: https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/2016-health-status-canadians/page-3-what-health-indicator.html

  • Canadian Institute for Health Information (2018) Drug use among seniors in Canada. CIHI, Ottawa, ON, p 2016

    Google Scholar 

  • Castelino RL, Bajorek BV, Chen TF (2010) Retrospective evaluation of home medicines review by pharmacists in older Australian patients using the Medication Appropriateness Index. Ann Pharmacother 44(12):1922–1929

    Article  Google Scholar 

  • Chen TF (2016) Pharmacist-led home medicines review and residential medication management review: the Australian model. Drugs Aging 33(3):199–204

    Article  Google Scholar 

  • Committee on the Learning Health Care System in America, Institute of Medicine (2013) Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

  • Department of Health | History of key MBS primary care initiatives 1999–2013 [Internet]. Www1.health.gov.au. 2019 [cited 20 December 2019]. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-History

  • Department of Health | Medication Management Review Data (2020) Www1.health.gov.au. [online] Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/Medication-Management-Review-Data [Accessed 30 Jan. 2020]

  • Department of Health | Medication management reviews (2019) [Internet]. Www1.health.gov.au. [cited 20 December 2019]. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/medication_management_reviews.htm

  • Faraoni D, Schaefer ST (2016) Randomized controlled trials vs. observational studies: why not just live together? BMC Anesthesiol 16(1):102–103

    Article  Google Scholar 

  • Freund DA, Dittus RS (1992) Principles of pharmacoeconomic analysis of drug therapy. Pharmacoeconomics 1(1):20–29

    Article  CAS  Google Scholar 

  • Fried TR, McGraw S, Agostini JV, Tinetti ME (2008) Views of older persons with multiple morbidities on competing outcomes and clinical decision-making. J Am Geriatr Soc 56(10):1839–1844

    Article  Google Scholar 

  • Godwin M, Gadag V, Pike A, Pitcher H, Parsons K, McCrate F et al (2015) A randomized controlled trial of the effect of an intensive 1-year care management program on measures of health status in independent, community-living old elderly: the Eldercare project. Fam Pract 33(1):37–41

    Article  Google Scholar 

  • Gudi SK, Kashyap A, Chhabra M, Rashid M, Tiwari KK (2019) Impact of pharmacist-led home medicines review services on drug-related problems among the elderly population: a systematic review. Epidemiol Health 41:e2019020

    Article  Google Scholar 

  • Hallberg IR, Kristensson J (2004) Preventive home care of frail older people: a review of recent case management studies. J Clin Nurs 13:112–120

    Article  Google Scholar 

  • Han PK, Lee M, Reeve BB, Mariotto AB, Wang Z, Hays RD et al (2012) Development of a prognostic model for six-month mortality in older adults with declining health. J Pain Symptom Manag 43(3):527–539

    Article  Google Scholar 

  • Hanna M, Larmour I, Wilson S, O’Leary K (2016) The impact of a hospital outreach medication review service on hospital readmission and emergency department attendances. J Pharm Pract Res 46(2):112–121

    Article  Google Scholar 

  • Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA et al (2019) Cochrane Handbook for Systematic Reviews of Interventions, 2nd edn. John Wiley & Sons, Chichester (UK)

    Book  Google Scholar 

  • Hoffmann W, van den Berg N, Thyrian JR, Fiss T (2011) Frequency and determinants of potential drug-drug interactions in an elderly population receiving regular home visits by GPs—results of the home medication review in the AGnES-studies. Pharmacoepidemiol Drug Saf 20(12):1311–1318

    Article  Google Scholar 

  • Hogg W, Lemelin J, Dahrouge S, Liddy C, Armstrong CD, Legault F et al (2009) Randomized controlled trial of anticipatory and preventive multidisciplinary team care. Can Fam Physician 55(12):e76

    PubMed  PubMed Central  Google Scholar 

  • Holland R, Lenaghan E, Harvey I, Smith R, Shepstone L, Lipp A et al (2005) Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. BMJ 330(7486):293

    Article  Google Scholar 

  • Hugtenburg J, Borgsteede S, Beckeringh J (2009) Medication review and patient counselling at discharge from the hospital by community pharmacists. Pharm World Sci 31(6):630–637

    Article  CAS  Google Scholar 

  • Hunt V, Anderson D, Lowrie R, Montgomery Sardar C, Ballantyne S, Bryson G et al (2018) A non-randomised controlled pilot study of clinical pharmacist collaborative intervention for community dwelling patients with COPD. npj Primary Care Respir Med 28(1)

  • Köberlein-Neu J, Mennemann H, Hamacher S, Waltering I, Jaehde U, Schaffert C et al (2016) Interprofessional medication management in patients with multiple morbidities. Deutsches Aerzteblatt Online

  • Kwint HF, Faber A, Gussekloo J, Bouvy ML (2012) The contribution of patient interviews to the identification of drug-related problems in home medication review. J Clin Pharm Ther 37(6):674–680

    Article  CAS  Google Scholar 

  • Lenaghan E, Holland R, Brooks A (2007) Home-based medication review in a high risk elderly population in primary care—the POLYMED randomised controlled trial. Age Ageing 36(3):292–297

    Article  Google Scholar 

  • Malet-Larrea A, Goyenechea E, García-Cárdenas V, Calvo B, Arteche JM, Aranegui P et al (2016) The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. Br J Clin Pharmacol 82(3):831–838

    Article  Google Scholar 

  • Mangin D, Bahat G, Golomb BA, Mallery LH, Moorhouse P, Onder G et al (2018) International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): position statement and 10 recommendations for action. Drugs Aging 35(7):575–587

    Article  Google Scholar 

  • Marek K, Stetzer F, Ryan P, Bub L, Adams S, Schlidt A et al (2013) Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication. Nurs Res 62(4):269–278

    Article  Google Scholar 

  • Naylor M, Brooten D, Campbell R, Jacobsen B, Mezey M, Pauly M et al (1999) Comprehensive discharge planning and home follow-up of hospitalized elders. JAMA 281(7):613

    Article  CAS  Google Scholar 

  • Nazareth I, Burton A, Shulman S, Smith P, Haines A, Timberall H (2001) A pharmacy discharge plan for hospitalized elderly patients—a randomized controlled trial. Age Ageing 30(1):33–40

    Article  CAS  Google Scholar 

  • Niebruegge B, Holbrook J, Vernon C, Grotton C, Maric A (2019) The future of population medicine: investigating the role of advanced practice providers and simulation education in special patient populations. Disease-a-Month. 65(7):221–244

    Article  Google Scholar 

  • Olesen C, Harbig P, Buus K, Barat I, Damsgaard E (2013) Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients. Int J Clin Pharm 36(1):163–171

    Article  Google Scholar 

  • Pacini M, Smith RD, Wilson EC, Holland R (2007) Home-based medication review in older people. Pharmacoeconomics 25(2):171–180

    Article  Google Scholar 

  • Payne RA (2016) The epidemiology of polypharmacy. Clin Med (Lond) 16(5):465–469

    Article  Google Scholar 

  • PROSPERO (2019) [Internet]. Crd.york.ac.uk. [cited 20 December 2019]. Available from: https://www.crd.york.ac.uk/PROSPERO/

  • Rytter L, Jakobsen H, Rønholt F, Hammer A, Andreasen A, Nissen A et al (2010) Comprehensive discharge follow-up in patients’ homes by GPs and district nurses of elderly patients. Scand J Prim Health Care 28(3):146–153

    Article  Google Scholar 

  • Sidel V, Beizer J, Lisi-Fazio D, Kleinmann K, Wenston J, Thomas C et al (1990) Controlled study of the impact of educational home visits by pharmacists to high-risk older patients. J Community Health 15(3):163–174

    Article  CAS  Google Scholar 

  • Stewart S, Horowitz J (2002) Detecting early clinical deterioration in chronic heart failure patients post-acute hospitalisation-a critical component of multidisciplinary, home-based intervention? Eur J Heart Fail 4(3):345–351

    Article  Google Scholar 

  • Stewart S, Pearson S, Horowitz J (1998) Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med 158(10):1067

    Article  CAS  Google Scholar 

  • Tan EC, Stewart K, Elliott RA, George J (2014) Pharmacist services provided in general practice clinics: a systematic review and meta-analysis. Res Soc Adm Pharm 10(4):608–622

    Article  Google Scholar 

  • Wastesson J, Morin L, Tan E, Johnell K (2018) An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf 17(12):1185–1196

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the assistance of Robin Featherstone and Lana Atkinson, Alberta SPOR SUPPORT Unit KT Platform, for developing and executing the literature search.

Funding

This study was not funded.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada

    Sarah M. Abu Fadaleh, Theresa L. Charrois, Tatiana Makhinova & Cheryl A. Sadowski

  2. School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada

    Dean T. Eurich

  3. Faculty of Medicine & Dentistry, 4-490A Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave, Edmonton, Alberta, T6G 1C9, Canada

    Sholeh Rahman

Authors
  1. Sarah M. Abu Fadaleh
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  2. Theresa L. Charrois
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  5. Sholeh Rahman
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Corresponding author

Correspondence to Cheryl A. Sadowski.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethics Approval

This is a systematic review. The University of Alberta Research Ethics Board has confirmed that no ethical approval is required.

Consent

This is a systematic review. Consent was not required.

Authors’ contributions

Sarah Abu Fadaleh was responsible for conceptualization, methodology, software, validation, formal analysis, investigation, data curation, writing—original and draft, and writing—review and editing, visualization,

Theresa Charrois was responsible for conceptualization, methodology, writing—original and draft, and writing—review and editing, visualization.

Tatiana Makhinova was responsible for conceptualization, methodology, writing—review and editing.

Dean Eurich was responsible for conceptualization, methodology, writing—review and editing.

Sholeh Rahman was responsible for methodology, software, investigation, validation, data curation, writing—original and draft, and writing—review and editing.

Cheryl Sadowski was responsible for conceptualization, methodology, formal analysis, resources, data curation, writing—original and draft, and writing—review and editing, visualization, supervision, project administration, and funding acquisition.

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Key points

1. Internationally, there is tremendous diversity in the types of HMR programs, participants, and outcomes.

2. HMR shows a minimal benefit in reducing the use of health care services.

3. HMR is a strategy for improved medication management.

4. HMR shows marginal effects on improving quality of life and mortality in older adults.

Supplementary Information

ESM 1

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ESM 2

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ESM 3

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Appendix A: Search Strategy

Appendix A: Search Strategy

Database: Ovid MEDLINE® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily 1946 to March 15, 2019.

Date conducted: 15 March 2019.

Strategy:

1 Drug Therapy/ and utli?ation.tw,kf. (369).

2 Drug Utilization Review/ (3600).

3 Inappropriate Prescribing/pc [Prevention & Control] (842).

4 Medication Adherence/ (16002).

5 Medication Reconciliation/ (908).

6 Polypharmacy/ (4173).

7 ((adhere* or complian* or nonadhere* or non-adhere* or noncomplian* or non-complianc*) adj6 (drug* or medication* or regimen* or treatment*)).tw,kf. (53628).

8 exp. “Treatment Adherence and Compliance”/ (223927).

9 ((assess* or check* or evaluat* or manage* or review*) adj2 (multiple medication* or medication load* or poly-medication* or poly-pharmacy* or polymedication* or polypharmacy*)).tw,kf. (193).

10 (de-prescribing or deprescribing).tw,kf. (406).

11 ((drug utili#ation* or drug regimen*) adj1 review*).tw,kf. (418).

12 (inappropriate prescri*).tw,kf. (1631).

13 (potentially inappropriate medication*).tw,kf (819).

14 Inappropriate Prescribing/ (2523).

15 Potentially Inappropriate Medication List/ (269).

16 ((medication* or medicines) adj2 (management* or reconcil* or review*)).tw,kf. (8539).

17 (pharmacist* adj3 consult*).tw,kf. (770).

18 or/1–17 [Combined MeSH& text words for medication reviews] (78738).

19 Community Pharmacy Services/ and (home* or house*).mp. (320).

20 Home Care Services/ (31984).

21 Home Care Services, Hospital-Based/ (1836).

22 Home Health Nursing/ (264).

23 House Calls/ (3243).

24 (home adj2 (based or service* or visit*)).tw,kf. (16644).

25 hospital at home.tw,kf. (393).

26 house call*.tw,kf. (618).

27 ((doctor* or health professional* or nurse* or pharmacist* or physician*) adj3 visit*).tw,kf. (12822).

28 or/19–27 [Combined MeSH& text words for home visits] (63313).

29 Age Factors/ (431231).

30 exp. Aged/ (2914938).

31 Aged, 80 and over (836942).

32 Aging/ (219147).

33 Geriatric Assessment/ (24974).

34 ((adult* or citizen* or individual* or people or person* or resident*) adj1 (older* or senior* or geriatric*)).tw,kf. (108781).

35 community-dwelling*.tw,kf. (20304).

36 elderly*.tw,kf. (229742).

37 frail*.tw,kf. (18360).

38 ((post-menopausal or postmenopausal) adj3 wom?n).tw,kf. (40986).

39 or/29–38 [Combined MeSH & text words for older adults] (3424210).

40 and/18,28,39 [Combined concepts for medication review, home-based & older adults] (838).

41 limit 40 to yr=“1990-Current” (823).

42 remove duplicates from 41 (822).

Table 1 Study characteristics and outcomes
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Table 2 Summary quality appraisal
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Abu Fadaleh, S.M., Charrois, T.L., Makhinova, T. et al. The effect of home medication review in community-dwelling older adults: a systematic review. J Public Health (Berl.) 30, 1857–1872 (2022). https://doi.org/10.1007/s10389-020-01447-0

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