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Medication Reviews Do Not Improve Care


January 25, 2017

The authors of a recent systematic review concluded that medication reviews did not have an effect on a number of health factors, including patient quality of life and certain clinical outcomes, such as mortality, in the studies they analyzed. These findings suggest that healthcare professionals may want to refrain from performing them as standard care.
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Medication review is frequently recommended to lower preventable adverse drug events and hospitalization rates, optimize medication use, and improve health outcomes. It involves a structured evaluation of the patient’s medications.

Victor Johan Bernard Huiskes, Department of Pharmacy, Sint Maartenskliniek, and colleagues note that most previous systematic reviews examining the effect of medication review also included “co-interventions and prolonged medication optimization interventions” that last longer than 3 months and concentrated on very specific outcome measures and patient groups, such as the elderly.

However, “In clinical practice, for each individual patient, medication review is mostly operationalized as an isolated intervention during a short term intervention period,” the authors write in the study.

For this systematic review, they decided to look at the effectiveness of medication review as an isolated intervention during a short-term intervention period (˂3 months), regardless of factors such as patient characteristics, outcome measures, and setting.

The authors did literature searches in MEDLINE, EMBASE and Web of Science and identified 31 randomized controlled trials with sample sizes ranging from 64 to 2014 patients that met the inclusion criteria.

They found that medication review had no effect on the clinical outcomes of mortality, hospital admissions and healthcare use, physical and cognitive functioning, and the number of patients falling in these studies. It did, however, result in a reduction in the number of falls per patient. They also reported that medication review had no effect on quality of life. The evidence about the effect on economical outcome measures was inconclusive.

Huiskes and colleagues discovered that medication review had an effect on most drug-related outcome measures, including the numbers of drugs, drug changes, drug-related problems, and drugs with a dosage decrease. It did not have an effect on the number of drugs with a dosage increase.

“Although an isolated medication review during a short term intervention period (how it is mostly operationalized in practice) has an effect on most drug-related outcomes, medication review has minimal effect on clinical outcomes, no effect on quality of life and no conclusion could be drawn about the effect on economical outcome measures,” the authors concluded. “Therefore, it should be considered to stop performing cross-sectional medication reviews as standard care.”

They suggest that efforts should be focused on the development and evaluation of other medication improvement strategies, such as individualized and longitudinal medication therapy management.

This study was published in BMC Family Practice.--Meredith Edwards White

Reference

Huiskes VJB, Burger DM, van den Ende CHM, van den Bemt BJF. Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials. BMC Family Practice. 2017;18:5. doi:10.1186/s12875-016-0577-x.

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