Drugs & Aging

, Volume 30, Issue 2, pp 91–102 | Cite as

The Relationship between the Extent of Collaboration of General Practitioners and Pharmacists and the Implementation of Recommendations Arising from Medication Review

A Systematic Review
  • Henk-Frans KwintEmail author
  • Lynette Bermingham
  • Adrianne Faber
  • Jacobijn Gussekloo
  • Marcel L. Bouvy
Systematic Review



Many studies have investigated the effect of medication review on a variety of outcomes, but the elements of the interventions have been quite diverse. Moreover, implementation rates of recommendations also vary widely between studies.


The objective of this study was to investigate how the extent of collaboration between the general practitioner (GP) and the pharmacist impacts on the implementation of recommendations arising from medication review.


MEDLINE, EMBASE and Web of Science were searched for studies published between January 2000 and April 2012. Keywords included medication review, medication therapy management, pharmaceutical services and drug utilization review. Sixteen articles (describing 14 randomized controlled trials [RCTs]) out of 620 titles met the inclusion criteria. Inclusion criteria for the review were medication review, RCT design, involvement of both pharmacist and GP, and home-dwelling patients (mean age >70 years) who had not been recently discharged. After quality assessment of the article, the presence of the following eight key elements reflecting collaboration were scored for each intervention: pharmacist with clinical experience, own pharmacist involved, sharing of medical records, patient interview by pharmacist, invitation of patients by GP, case conference between GP and pharmacist, action plan, follow-up. The primary outcome was the implementation rate of recommendations. Meta-regression analysis was used to assess the association between the implementation rate and the number of key elements present.


Twelve RCTs were included after quality assessment. The mean number of key elements within the intervention was 5.2 (range 1–8). The mean implementation rate of recommendations was 50 % (range 17–86). The association between the number of key elements present in the intervention and the implementation rate of recommendations was significant: β = 0.085 (95 % CI 0.052–0.128; p < 0.0001).


This systematic review shows a significant association between the number of key elements of the intervention reflecting collaborative aspects in medication review and the implementation rate of recommendations.


General Practitioner Medication Review Case Conference Implementation Rate General Practitioner Practice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No funds were received for conducting this review. All authors declare that they have no conflict of interests that are directly relevant to the content of this study. The authors thank J.C. Riemens-Louisse, student, for her contribution to the data extraction forms and quality assessment forms and S.V. Belitser for her contribution to the statistical analysis.

Supplementary material

40266_2012_48_MOESM1_ESM.pdf (136 kb)
Supplementary material 1 (PDF 135 kb)


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Henk-Frans Kwint
    • 1
    • 2
    Email author
  • Lynette Bermingham
    • 3
  • Adrianne Faber
    • 2
  • Jacobijn Gussekloo
    • 3
  • Marcel L. Bouvy
    • 1
    • 2
  1. 1.Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical Sciences (UIPS)UtrechtThe Netherlands
  2. 2.SIR Institute for Pharmacy Practice and PolicyLeidenThe Netherlands
  3. 3.Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands

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