A systematic review and meta-analysis of pharmacist-led fee-for-services medication review
Article first published online: 20 DEC 2013
© 2013 The British Pharmacological Society
British Journal of Clinical Pharmacology
Volume 77, Issue 1, pages 102–115, January 2014
How to Cite
Hatah, E., Braund, R., Tordoff, J. and Duffull, S. B. (2014), A systematic review and meta-analysis of pharmacist-led fee-for-services medication review. British Journal of Clinical Pharmacology, 77: 102–115. doi: 10.1111/bcp.12140
- Issue published online: 20 DEC 2013
- Article first published online: 20 DEC 2013
- Accepted manuscript online: 18 APR 2013 02:39AM EST
- Manuscript Accepted: 11 MAR 2013
- Manuscript Received: 9 JAN 2013
- School of Pharmacy, University of Otago, New Zealand
- Universiti Kebangsaan Malaysia
- Ministry of Higher Education Malaysia
- community pharmacy services;
- drug use review;
- medication review;
- medication therapy management;
- outcome assessment (health care)
The aim was to examine the impact of fee-for-service pharmacist-led medication review on patient outcomes and quantify this according to the type of review undertaken, e.g. adherence support and clinical medication review.
Relevant published studies were identified from Medline, Embase and International Pharmaceutical Abstract databases (from inception to February 2011). Study inclusion criteria were fee-for-service medication review, presence of a control group and pre-specified patient outcomes. Outcomes were grouped into primary (changes in biomarkers, hospitalization, and mortality) and secondary outcomes (medication adherence, economic implications and quality of life). Meta-analyses for primary outcomes were conducted using random effects models and secondary outcomes were summarized using descriptive statistics.
Of the 135 relevant articles located, 21 studies met the inclusion criteria for primary outcomes and 32 for secondary outcomes. Significant results favouring pharmacists' intervention were found for blood pressure (OR 3.50, 95% CI 1.58, 7.75, P = 0.002) and low density lipoprotein (OR 2.35, 95% CI 1.17, 4.72, P = 0.02). Outcomes on hospitalization (OR 0.69, 95% CI 0.39, 1.21, P = 0.19) and mortality (OR 1.50, 95% CI 0.65 to 3.46, P = 0.34) indicated no differences between the groups. On subgroup analysis, clinical medication review (OR 0.46, 95% CI 0.26, 0.83, P = 0.01) but not adherence support review (OR 0.88, 95% CI 0.59, 1.32, P = 0.54) reduced hospitalization.
The majority of the studies (57.9%) showed improvement in medication adherence. Fee-for-service pharmacist-led medication reviews showed positive benefits on patient outcomes. Interventions that include a clinical review had a significant impact on patient outcomes by attainment of target clinical biomarkers and reduced hospitalization.