A systematic review and meta-analysis of pharmacist-led fee-for-services medication review

Abstract

Aim: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: community pharmacy services; drug use review; hospitalization; medication review; medication therapy management; outcome assessment (health care).

Figure 1

Systematic review inclusion and exclusion flowchart

Figure 2

Forest plot for blood pressure, LDL, hospitalization and mortality outcomes. OR is >1 when medication review increased the number of patients achieving the target BP. OR is >1 when medication review increased the number of patients achieving the target LDL. OR is <1 when medication review reduced hospitalization. OR is <1 when medication review reduced mortality

Figure 3

Forest plot of combined primary outcomes. OR is >1 when medication review decreased hospitalization or increased attainment of target control

Figure 4

Forest plot of hospitalization outcome for studies with clinical medication review. OR is <1 when medication review reduced hospitalization