Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review

Purpose To identify the evidence that supports the effect of interventions made by hospital pharmacists, individually or in collaboration with a multidisciplinary team, in terms of healthcare outcomes, a more effective utilization of resources and lower costs in older polymedicated inpatients. Methods We searched the following databases: MEDLINE, EMBASE and the Cochrane Library. We also conducted a hand search by checking the references cited in the primary studies and studies included in reviews identified during the process of research. Four review authors working by pairs searched for studies, extracted data, and drew up the results tables. Results Twenty-six studies were included in the review. In 13 of them pharmacists carried out their intervention exclusively while the patients were in hospital, whereas in 13 interventions were delivered during admission and after hospital discharge. Outcomes identified were mortality, length of stay, visits to the emergency department, readmissions and reported quality of life, among others. Pharmacist interventions were found to be beneficial in fifteen studies, specifically on hospital readmissions, visits to the emergency department and healthcare costs. Conclusion There is no hard evidence demonstrating the effectiveness of hospital pharmacist interventions in older polymedicated patients. Mortality does not show as a relevant outcome. Other health care outcomes, such as hospital readmissions, visits to the emergency department and healthcare costs, seem to be more relevant and amenable to change. Interventions that include pharmacists in multidisciplinary geriatric teams seem to be more promising that isolated pharmacist interventions. Interventions prolonged after hospital discharge seem to be more appropriate that interventions delivered only during hospital admission. Better-designed studies should be conducted in the future to provide further insight into the effect of hospital pharmacist interventions. Key summary pointsAim Do patients receiving polypharmacy benefit from interventions by hospital pharmacists, individually or as part of a multidisciplinary team? Findings Some beneficial effects were found of pharmacist interventions in 15 of 26 studies, specifically on hospital readmission, visits to the emergency department and healthcare costs. Message Evidence in favour of hospital pharmacist interventions in polymedicated older patients is scarce. Well-designed studies, with clearly defined interventions, outcomes and follow-up times should be conducted in the future to define the role of pharmacists in the geriatric team.