Pharmacists' role in interventions addressing excessive polypharmacy: a scoping review

Area of Science:

• Pharmacy Practice
• Geriatric Medicine
• Public Health

Background:

• Excessive polypharmacy (≥10 medications) increases risks like adverse drug events, hospitalizations, and mortality.
• Pharmacists' expertise in medication management positions them to mitigate these risks.
• Understanding pharmacists' roles in addressing polypharmacy is crucial for improving patient outcomes and healthcare efficiency.

Purpose of the Study:

• To review and synthesize literature on the multifaceted roles of pharmacists in managing excessive polypharmacy.
• To identify different care settings where pharmacists intervene.
• To highlight gaps in current research regarding pharmacist-led polypharmacy interventions.

Main Methods:

• A comprehensive scoping review was conducted using Arksey and O'Malley's framework, enhanced by Levac et al.
• Searches were performed across five major databases (MEDLINE, EMBASE, PubMed, CINAHL, Cochrane CENTRAL) up to June 2024.
• Data extraction and analysis followed PRISMA-ScR guidelines, employing narrative synthesis.

Main Results:

• Nineteen studies, primarily from high-income countries and published post-2019, were included.
• Pharmacists' interventions occurred in primary care, hospitals, home care, and long-term care, but notably absent in community pharmacies.
• Key roles identified include medication reconciliation, appropriateness assessment, prescriber education, and patient monitoring, emphasizing collaboration and utilizing polypharmacy management tools.

Conclusions:

• Pharmacists actively manage excessive polypharmacy through diverse roles across various healthcare settings.
• Factors influencing these roles include scope of practice, interprofessional proximity, and specialized training.
• Further investigation into community pharmacy interventions is warranted.