Evaluating general practice pharmacist-led medicines reviews on prescribing appropriateness and patient-reported outcomes

Background: While the majority of pharmacist-led medicines reviews measure prescribing appropriateness, there is limited evidence of such reviews’ effects on patient-reported outcome measures, especially in general practice settings, as these roles are not yet commonplace in most countries worldwide.
Aim: To investigate the impact of general practice pharmacist-led person-centred medicines reviews involving the ‘7 steps to appropriate polypharmacy’ approach on prescribing appropriateness, polypharmacy indicators (markers of high-risk prescribing), and patient-reported outcome measures (PROMs).
Method: Four pharmacists performed person-centred medicines reviews for patients with hyperpolypharmacy (prescribed C 10 regular medicines) and/or at high risk of medicines-related harm in ten general practices between January 2021 and December 2022. Recommendations were provided to the general practitioner and followed up with the patient and/or healthcare professionals as appropriate. Pre and post intervention: i) polypharmacy indicators were recorded, and ii) for a sample of patients, the Person-Centred Medication Appropriateness Index (PC-MAI) scores and PROMs were collected. Descriptive statistics were performed for patient characteristics and the outcome measures.
Results: Of the 1,471 included patients, the mean age was 76 years (standard deviation [SD]: 9.7), and the mean number of medicines was 13.8 (SD: 4.7) pre review (88.4% had hyperpolypharmacy). A total of 1,056 polypharmacy indicator occurrences were identified (mean 0.72/person), with C 1 identified in 47.1% of patients. The most common occurrences were bleeding-related (29.5%), fall-related (22.8%), and renal-related (13.2%). The overall resolution rate was 70.7%; it was highest for electrolyte abnormality and renal domains (90.7% and 90.6%) and lowest for the falls domain (34%). Pre- and post-review PC-MAI scores were calculated for 194 patients, with a reduction in PC-MAI score for 99.5% of patients. The mean prereview PC-MAI was 27.0 (SD 15.0; range 4–99) and post-review PCMAI was 9.8 (SD 9.9; range 0–66). The mean PC-MAI reduction was 17.4 (SD 10.8; range 0–54) and 1.2 per medicine. PROMs were gathered for 179 patients, of whom 87.7% reported improvements in their understanding of their medicines, 63.1% in their experience of adverse drug reactions, 36.9% in their adherence, and 30.5% in the impact of medicines on their activities of daily living.
Conclusion: General practice pharmacist-led person-centred medicines reviews for patients with hyperpolypharmacy and/or at high-risk of medicines-related harm result in substantial improvements in prescribing appropriateness and several important patientreported outcomes—including patients’ medicines understanding, adherence, and medicines-related harm. Therefore, this study provides evidence to support the wider implementation of these comprehensive medicines reviews in regions where these pharmacist roles are currently not in place in primary care settings.