Background: Few studies have evaluated roles of general practice-based pharmacists (PBPs), particularly in optimizing medicines management for older people with both multimorbidity and polypharmacy.
Objective: To explore the types and effectiveness of services provided by PBPs, either alone or in collaboration with other primary health care professionals, that sought to optimize medicines management for older people with multimorbidity and polypharmacy.
Methods: Eight electronic databases and three trial registries were searched for studies published in English until April 2020. Inclusion criteria were randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of services delivered by PBPs in primary care/general practice, for patients aged ≥65 years with both multimorbidity and polypharmacy that focused on a number of outcomes. The Cochrane risk of bias tool for randomized trials (RoB 1) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool were used for quality assessment. A narrative synthesis was conducted due to study heterogeneity.
Results: Seven studies met inclusion criteria. All included studies employed PBP-led medication review accompanied by recommendations agreed and implemented by general practitioners. Other patient-level and practice-level interventions were described in one study. The limited available evidence suggested that PBPs, in collaboration with other practice team members, had mixed effects on outcomes focused on optimizing medicines management for older people. Most included studies were of poor quality and data to estimate the risk of bias were often missing.
Conclusion: Future high-quality studies are needed to test the effects of PBP interventions on a well-defined range of medicines management-related outcomes.
Keywords: Multimorbidity; older people; polypharmacy; practice-based pharmacists; primary health care; systematic review.
Optimizing medicines use for older people (aged ≥ 65 years) with multimorbidity (the presence of two or more long-term conditions) and polypharmacy (the concomitant use of four or more medicines) is urgent due to an ageing population which commonly has complex medications regimens. It is anticipated that pharmacists who have been integrated into general practices [also called practice-based pharmacists (PBPs)] will positively impact on patient outcomes through various roles and activities. As the role of PBPs is relatively new, little is known about the exact nature of their role and how these pharmacists will optimize medicines management for older people in a patient-centred manner. The aim of this research was to provide a detailed understanding of how PBPs may enhance optimization of medication management in older people and to study the effects of PBPs’ interventions on outcomes-focused on optimizing medicines management for older people with multimorbidity and polypharmacy such as quality of life. The seven included studies indicated that PBP-led interventions such as medication reviews improved a number of outcomes but had either a limited effect or no effect on other outcomes. Further high-quality research is needed in this area.
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