The Relationship between the Extent of Collaboration of General Practitioners and Pharmacists and the Implementation of Recommendations Arising from Medication Review
- 631 Downloads
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.
KeywordsGeneral Practitioner Medication Review Case Conference Implementation Rate General Practitioner Practice
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.
- 5.Shaw J, Seal R, Pilling M. Task force on medicines partnership and the national collaborative medicines management services programme. Room for review: a guide to medication review. 2002. http://www.npc.nhs.uk/review_medicines/intro/resources/room_for_review.pdf. Accessed 21 Feb 2012.
- 6.Clyne W, Blenkinsopp A, Seal R. National prescribing centre. A guide to medication review. 2008. http://www.npc.nhs.uk/review_medicines/intro/resources/agtmr_web1.pdf. Accessed 22 Feb 2012.
- 10.Nkansah N, Mostovetsky O, Yu C, Chheng T, Beney J, Bond CM, et al. Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev 2010;(7):CD000336.Google Scholar
- 12.Urbis Keys Young. Evaluation of the home medicines review program (pharmacy component): final report. 2005. http://www.beta.guild.org.au/uploadedfiles/Medication_Management_Reviews/Overview/Urbis%20Keys%20Young%20evaluation.pdf. Accessed 21 Feb 2012.
- 14.Niquille A, Lattman C, Bugnon O. Medication reviews led by community pharmacists in Switzerland: a qualitative survey to evaluate barriers and facilitators. Pharm Pract. 2010;8:35–42.Google Scholar
- 29.Volume CI, Farris KB, Kassam R, Cox CE, Cave A. Pharmaceutical care research and education project: patient outcomes. J Am Pharm Assoc. 2001;41:411–20.Google Scholar
- 30.Kassam R, Farris KB, Burback L, Volume CI, Cox CE, Cave A. Pharmaceutical care research and education project: pharmacists’ interventions. J Am Pharm Assoc. 2001;41:401–10.Google Scholar