Core components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review
Authors: Craske M E , Hardeman W , Steel N , Twigg M J 
Published: April 2024

Abstract

Introduction
Medication reviews are a recognised intervention undertaken by healthcare professionals to support patients prescribed multiple medicines or with complex medication regimens. Pharmacist-led medication reviews are now an established intervention in policy and practice. There are different types of medication review, each implemented differently. Huiskes et al. demonstrated that medication reviews undertaken by any professional in any setting had minimal effects on clinical outcomes and that evidence is lacking about their effect on economic outcomes.[1] The implementation of medication reviews in practice was recognised as a factor which may impact outcomes, but this has not been explored further.

Aim
To develop an initial programme theory that links the core components of pharmacist-led medication reviews to outcomes in different contexts.

Methods
A systematic review was conducted to identify randomised controlled trials of medication reviews in adults (18+). The review updated that by Huiskes et al. and used the same search strategy in the MEDLINE, EMBASE and Web of Science databases.[1] The search terms used were related to ‘medication review’, ‘pharmacist’ and ‘randomised controlled trial’. Medication review was defined as “a consultation between a pharmacist and a patient to review the patient’s total medicines use with a view to improve patient health outcomes and minimise medicines related problems”. Studies reporting any outcomes were included. Papers not published in English or not available as full texts were excluded. The Cochrane Risk of Bias 2.0 tool was used to assess the studies. Data were extracted using a previously piloted bespoke data collection form. Descriptions of the medication reviews’ core components, implementation and outcomes were narratively synthesised to draw out common themes. The GRADE framework informed the overall assessment of the quality of the evidence from the studies.[2]

Results
Records screened n=10947, total reports of studies included n=68. Of the 50 individual studies that were identified, 66% were assessed as having a high risk of bias. Narrative synthesis of the data extracted relating to the description and implementation of the medication reviews, and where and how this may have affected outcomes, is presented in our programme theory as core components. Collaborative working may help reduce medicines-related problems and number of medicines prescribed. Patient involvement in goal setting and action planning may improve patients’ ability to take medicines as prescribed and help them achieve their treatment goals. Additional support and follow-up may lead to improved blood pressure, diabetes control, quality of life and a reduction of medicines-related problems.

Conclusion
This is an extensive systematic review that has explored pharmacist-led medication reviews in all settings and resulted in the production of a draft programme theory. It is best practice for stakeholders to be involved in the development of a programme theory. Providers of medication reviews can evaluate their processes and consider if and how these core components are implemented in their service provision. This initial programme theory will be refined and discussed in future research.

References
1. Huiskes VJB, Burger DM, Van Den Ende CHM et al. Effectiveness of medication review: A systematic review and meta-analysis of randomized controlled trials. BMC Fam Pract. 2017;18.
2. Guyatt GH, Oxman AD, Kunz R et al. Going from evidence to recommendations. BMJ. 2008;336:1049–51.