| Alvarez 2001 | Pharmaceutical care | Pharmaceutical care is the provision of drug therapy for the purpose of achieving outcomes that improve a person’s quality of life. | Pharmacies in the intervention group provided pharmaceutical care, which consisted of offering the pharmaceutical care service to participants and to their corresponding GPs. | An Initial interview and assessment of the therapeutic plan was undertaken, registration of data during the subsequent visits to allow the identification of medication‐related problems, and an intervention to solve the problem. The intervention involved proposing changes in the medication participants received, which had to be communicated to the patient’s GP. | Pharmacists provided the intervention. | Individual and face‐to‐face |
| Bernsten 2001 | Pharmaceutical care | Pharmaceutical care is the provision of drug therapy for the purpose of achieving outcomes that improve a person's quality of life, although little research has been conducted in community‐based pharmaceutical care with elderly people. | Training of pharmacists was done with a study manual. The manual contained an overview of the concept of pharmaceutical care and its provision to elderly people. No reference was provided for the study manual. | The intervention group of pharmacists identified actual and potential drug‐related problems using a structured approach. These pharmacists utilised a number of data sources in this assessment including the participant, the participant's GP, and pharmacy records. Following this assessment, pharmacists were instructed to formulate an intervention and monitoring plan. | Community pharmacists were trained to provide the structured pharmaceutical care intervention. A study manual helped facilitate this process. It contained an overview of the concept of pharmaceutical care, its provision to elderly people, information on the therapeutic management of a number of disease states common in the elderly, together with other issues pertinent to drug therapy in the elderly. | Individual face‐to‐face |
| Campins 2016 | Drug evaluation and recommendation | Several instruments, criteria, and algorithms have been developed to enable more rational and appropriate use of medication, but limited evidence exists with regard to the outcomes that were investigated. | The Good Palliative‐Geriatric Practice algorithm Garfinkel 2007) and the STOPP/START criteria were used (O'Mahony 2015). Both of these tools assess the appropriate use of medication in older people. | The intervention was composed of 3 phases. In the first phase, an experienced pharmacist evaluated all prescriptions using the GP‐GP algorithm and based their decision about appropriateness on the STOPP/START criteria. In the second phase, the pharmacist discussed recommendations for each drug with the participant's physician in order to come up with a final list of recommendations. Finally, the recommendations were discussed with the participant and a final decision was agreed by physicians and participants. | The intervention was delivered by a trained and experienced pharmacist. No details are provided concerning what is a "trained and experienced" pharmacist. | Individual and face‐to‐face |
| Coleman 1999 | Chronic care clinics | Chronic care clinics redesign the structure and content of primary care services through the delivery of scheduled visits devoted to chronic disease management. This mode of service delivery has the potential to improve outcomes for elderly people. | The chronic care clinics included an extended visit with the physician and nurse dedicated to planning chronic disease management, a pharmacist visit that emphasised reduction of polypharmacy and high‐risk medications, and a patient self‐management group. | Frail older people were invited to participate in visits with the primary care team. During these visits, a shared treatment plan was developed, a session was conducted with the pharmacist that addressed polypharmacy and medications associated with functional decline, patient self‐management group sessions were conducted, and the provision of health status assessment information was provided to the practice team. | The team that provided the intervention consisted of the participant’s physician, a team nurse, and a pharmacist. Physicians and team nurses received training in population‐based medicine and management strategies of geriatric syndromes. Team nurses received on‐the‐job coaching from study staff. | The intervention was delivered individually and in groups in a face‐to‐face format. |
| Frankenthal 2014 | Medication review and drug recommendations | Potentially inappropriate prescriptions are prevalent in older people and are associated with adverse drug events. The STOPP/START criteria are designed to detect potentially inappropriate prescriptions in elderly people. However, little is known about the effects of an intervention involving the application of the STOPP/START criteria on clinical outcomes. | The STOPP/START criteria were used to deliver the intervention (Gallagher 2008). The STOPP criteria focus on avoiding the use of drugs that are potentially inappropriate for older people and the START criteria identify undertreatment or prescribing omissions in older people. | Medication reviews were conducted by the study pharmacist for all residents. Recommendations made by the pharmacist were discussed with the chief physician. The physician then decided whether to accept these recommendations and implement prescribing changes. | The intervention was conducted by the study pharmacist who applied the STOPP/START criteria during the medication review. The pharmacist also discussed the recommendations from the intervention with the chief physician, who decided whether to accept these recommendations and implement prescribing changes. | Intervention was delivered individually and face‐to‐face. |
| Garcia‐Gollarte 2014 | Structured educational intervention | Inappropriate drug prescription is a common problem in people living in nursing homes and is linked to adverse health outcomes. This study assessed the effect of an educational intervention directed to nursing home physicians in reducing inappropriate prescription and improving health outcomes and resource utilisation. | Educational material and references were given to physicians and two 1‐h workshops were used to review cases and promote practice changes. The STOPP/START criteria were reviewed with a random sample of 10 residents cared for by each physician (Gallagher 2008). The content of the educational intervention is provided in an appendix (Garcia‐Gollarte 2014). | The educational intervention included general aspects of prescription and drug use in geriatric patients, how to reduce the number of drugs, to perform a regular review of medications, to avoid inappropriate drug use, to discontinue drugs that do not show benefits, and to avoid under treatment with drugs that have shown benefits. It also discussed some drugs frequently related to adverse drug reactions in older people. | A nursing home physician delivered the structured educational intervention. | Face‐to‐face intervention delivered in a group and individual format. |
| Gernant 2016 | Medicine reconciliation and action plan | Emergency department overcrowding has been linked to increased mortality, costs, and length of stay. This study evaluated the effectiveness of a telephone‐based, medicines‐management service on reducing emergency department utilisation. | Medication therapy management was provided to participants (APA 2008). A pharmacy technician completed telephonic medication reconciliation, after which a trained pharmacist consulted with the participant or caregiver via telephone to complete a scheduled, comprehensive medication therapy review to identify and resolve any medication‐related problems. The pharmacist constructed a personal medication record and a medication‐related action plan for the participant. The action plan was a participant‐centred document that assisted participants, caregivers, and the pharmacist in the resolution of identified medication‐related problems. | The intervention commenced with a pharmacy technician completing medication reconciliation with the participant over the telephone. Then, a pharmacist consulted with the participant by telephone for an average of 30 min to complete a comprehensive medication review to identify and resolve medication‐related problems. The pharmacist constructed a person medication‐related action plan and followed‐up with the participant's prescriber. | A pharmacy technician delivered the initial medicine reconciliation with the participant. A trained pharmacist conducted the medication therapy review, constructed a personal medication record, and a medication‐related action plan. The pharmacist also followed up with the participant's prescriber for resolution of problems that could not be resolved with the participant. | The intervention was conducted individually on the telephone. |
| Gurwitz 2014 | Automated system to facilitate flow of information and provide warnings, alerts, and recommendations | Transitions between the impatient and outpatient setting is a period of high risk for older adults. Most approaches to improving transitions require a substantial commitment of resources but automating these processes may improve the quality and safety of care. | An automated system was used to facilitate the flow of information to the medical group's primary care providers about individuals who were discharged to home from the hospital (Field 2012). | An automated system was developed to facilitate the flow of information to the medical group's primary care providers. A computer interface linked the primary care provider's electronic health records to the hospital records, which provided information about admissions and discharges. The system also provided information about new drugs at discharge, warnings about drug‐drug interactions, recommendations about dose changes and laboratory monitoring of high‐risk medications, and alerts to the provider's support staff to schedule a post‐hospitalisation office visit within 1 week of discharge if not already scheduled. | The automated system delivered the intervention. | The intervention was delivered electronically. |
| Hawes 2014 | Care transitions clinic visit | Medication errors related to hospital discharge result in rehospitalisations and emergency department visits, which may be reduced by pharmacist involvement during postdischarge transitions of care. This study evaluated the impact of a transitional care clinic visit conducted by a pharmacist. | The Best Possible Medication Discharge List was used to identify medication discrepancies (Wong 2008). It served as the gold standard for the list of medications that the participant should take after discharge. | Participants in the intervention group were scheduled for a care transitions clinic visit approximately 72 h after hospital discharge. The visit involved performing a complete medication history, identifying and resolving medication discrepancies, creating a current medication list, and counselling on appropriate medication use. | Clinical pharmacists provided the intervention. They collaborated with the inpatient medical team to create the Best Possible Medication Discharge List. | The intervention was delivered individually and face‐to‐face. |
| Holland 2005 | Pharmacist home visits | Older people often have trouble adhering to their medications. This study evaluated the effectiveness of a home‐based medication review on hospital admissions among elderly people. | A standardised visit form was used to record the home visit but no reference was provided. | Pharmacists arranged home visits with the participant during which they assessed the participant's ability to self‐medicate and drug adherence. They educated the participant, removed out‐of‐date drugs, reported drug reactions or interactions to the physician, and reported the need for a compliance aid. | Pharmacists conducted the home visits. Pharmacists held a postgraduate qualification in pharmacy practice or had recent continuing professional development in therapeutics. The pharmacists participated in a 2‐day training course, which included lectures on adverse drug reactions, prescribing in elderly people, improving concordance, and communication skills. | The intervention was delivered individually and face‐to‐face. |
| Ibrahim 2013 | Telephone consultation with home visits | Adherence to warfarin treatment and monitoring guidelines may be suboptimal among patients and staff. This study assessed the improvement in adherence to warfarin therapy with telephone and home visits. | A predesigned set of questions was used in the telephone consultation, but no reference or any additional details were provided. | The intervention group was counselled with once‐a‐week telephone consultations and 2 home visits per month by either a nurse or a pharmacist that dealt with warfarin use. | A pharmacist or a nurse provided the home visits. The telephone consultation was conducted by a pharmacist. | The intervention was delivered individually using a face‐to‐face format and telephone calls. |
| Kaczorowski 2011 | Cardiovascular risk assessment and education sessions | Strategies for managing blood pressure are essential as high blood pressure is the leading risk factor for death. The study authors evaluated the effectiveness of a community‐based cardiovascular health promotion and disease prevention programme in reducing morbidity. | The Cardiovascular Health Awareness Program was a standardised intervention that consisted of 10 weeks of cardiovascular risk assessment, blood pressure measurements, and education sessions (CHAP 2017). | The intervention consisted of 10 weeks of cardiovascular risk factor assessment and educational sessions. Volunteers were recruited to help participants measure their blood pressure and supported self‐management by providing participants with their risk profile, risk‐specific educational materials and information about access to local services. At the end of the 10‐week programme and 6 months after the programme ended, the results were forwarded to family physicians who rank‐ordered their participants by their most recent systolic blood pressure reading. | Volunteers were recruited and trained to carry out the intervention. The volunteers were trained according to a standardised curriculum developed by a public health nurse and delivered by nurses working in the intervention community. | The intervention was conducted individually in a face‐to‐face manner. |
| Korajkic 2011 | Educational intervention with pharmacist | Few studies have examined a pharmacist's contribution to improving diuretic compliance and reducing rehospitalisation and health care use. This study aimed to determine the impact of a pharmacist‐led intervention on patient‐guided diuretic dose adjustment. | The intervention group adjusted their diuretic dose using a flexible frusemide dose‐adjustment guide that was provided in the paper. | The intervention consisted of a 30‐min educational session and focused on improving participant self‐care, recognising symptoms of fluid retention, measuring weight daily, self‐adjusting the diuretic dose and improving knowledge of heart failure and heart failure medications. | A pharmacist provided the intervention. The frusemide dose‐adjustment guide was developed in collaboration with cardiologists. | Conducted individually in a face‐to‐face fashion. |
| Krska 2001 | Pharmaceutical care plan | Regular medication reviews can reduce the risk of medication‐related problems. This study aimed to evaluate the effect of a pharmacist‐led medication review on pharmaceutical care issues and hospitalisations. | Clinically‐trained pharmacists completed a detailed profile for each participant using medical notes and computer records. All participants were interviewed in their home about their use of and responses to medication and their use of health and social services. No references provided | A pharmaceutical care plan was drawn up listing all pharmaceutical care issues together with all the actions planned to achieve the outcomes of any pharmaceutical care issue. Copies of the plan were given to the GP who was asked to agree, after which the pharmacist implemented the plan. | The pharmacist performed the medication review. The participants' GP indicated their level of agreement with each pharmaceutical care issue and with the actions taken. | The mode of delivery was individual and face‐to‐face. |
| Lapane 2011 | Use of health information technology to identify people at risk for delirium and falls, implement monitoring plans, and provide reports to pharmacists | Falls and delirium pose the greatest threats to resident safety in nursing homes and contributes to further functional decline. Medication use is associated with greater risk of delirium and falls. Therefore, this study used health information technology to identify residents at risk for delirium and falls due to adverse drug events. | A Geriatric Risk Assessment MedGuide was a database designed to identify medications that potentially contributed to delirium and fall risk (Tobias 1999). It also facilitated early recognition of signs and symptoms indicative of potential medication‐related problems. Training was provided to nursing staff and pharmacists in how to use the reports generated by the Geriatric Risk Assessment MedGuide. | Health information technology was used to identify residents at risk for delirium and falls, implement monitoring plans, and provide reports to pharmacists in conducting medication reviews. The consultant pharmacist shared the reports with the nurse contact at the facility and used the reports in their monthly drug review. | The intervention was an automated system that provided reports to pharmacists and nurses, who were trained to use these reports. The training for nurses provided information regarding medications that cause, aggravate, or contribute to the risk of falls and delirium. The course also reviewed symptoms and signs of adverse medication effects and reinforced the importance of the early observation of symptoms and signs of adverse medication effects. Pharmacists were trained to provide a targeted drug review for all participants who experienced delirium and falls. | The intervention was delivered individually and face‐to‐face. |
| Lenaghan 2007 | Home‐based medication review | Home‐based medication reviews are convenient for the patient and provide an opportunity to understand their medication‐taking in their home environment. Therefore, this study looked at whether home‐based medication reviews with elderly people could reduce hospital admissions. | The intervention comprised 2 home visits by a community pharmacist who educated the participant/carer about their medicines, noted any pharmaceutical care issues and assessed the need for an adherence aid. | At the home visit, the pharmacist educated the participant, removed out‐of‐date drugs, and assessed the need for an adherence aid. The pharmacist held regular meetings with the GP where changes to the participant's medications were discussed and amendments were implemented by the GP. | A pharmacist with a post‐graduate qualification in pharmacy practice conducted the home‐based medication review. They had regular meetings with the lead GP. Possible changes to the participant's medication were discussed and agreed amendments were implemented by the GP. | The intervention was delivered individually and face‐to‐face. |
| Lowrie 2012 | Pharmacist medication review | Although angiotensin‐converting enzyme inhibitors and beta‐blockers reduce morbidity and mortality in people with heart failure, these treatments are underused. Pharmacists may improve treatment through medication review. This study investigated whether a pharmacist intervention would reduce hospital admission and death for people with heart problems. | Pharmacists received training covering the aetiology, symptoms, and evidence‐based management of heart failure. They also participated in monthly discussions of specific cases. The pharmacist used guidelines to optimise treatment for participants with left ventricular systolic dysfunction. All of these materials are available at onlinelibrary.wiley.com/journal | Participants were offered a 30‐min appointment with the pharmacist If there was agreement between the pharmacist and the participant, and subsequently with the doctor, medications were initiated, discontinued, or modified by the pharmacist during 3‐4 weekly or fortnightly consultations. | The pharmacists, who delivered the medication review, had between 3 and 16 years of post‐qualification experience, had experience delivering primary care‐based medication review clinics for people receiving multiple‐drug treatment and attended an in‐house training day covering the aetiology, symptoms, and evidence‐based management of heart failure. An additional session covered the methods of the trial. | The intervention was delivered individually and face‐to‐face. |
| Malet‐Larrea 2016 | Pharmacist medication review | Aging and the use of polypharmacy are risk factors for drug‐related problems and medication‐related hospital admissions. Therefore, this study assessed the impact of a community pharmacist‐led medication review on hospital admissions in older people. | Pharmacists in the intervention group received a training course that covered the clinical management of older people and the medication review method. No reference was provided. | The medication review consisted of the pharmacist collecting information about the participant's health problems, medication use, lifestyle habits, and concerns about diseases and medications. The pharmacist then identified negative clinical outcomes related to medicines and drug‐related problems. Subsequently, an action plan was agreed upon which focused on participant outcomes and the medication use process. | Pharmacists provided the medication review. They received a 3‐day training course covering clinical management of elderly people, the medication review with follow‐up method, communication with participants and doctors, study protocol and documentation forms. | The intervention was delivered individually and face‐to‐face. |
| Malone 2000 | Pharmacist visits | Pharmacists have adopted pharmaceutical care, which is the provision of drug therapy to improve a person's quality of life, to reduce morbidity and mortality. Unlike previous studies that did not focus on people who were most likely to benefit, this study examined veterans who were at high risk for a medication‐related problem. | Contacts between the pharmacist and participant were recorded on a data collection form, which contained the method of contact, time spent, medical problems addressed, drug‐related problems addressed, and drug‐related problems resolved. This form was not referenced. | The intervention participants received consultation and follow‐up care from a clinical pharmacist. | Pharmacists conducted the intervention. Most had a Doctor of Pharmacy degree and over 70% were either receiving or had completed postgraduate training. | The intervention was delivered individually and face‐to‐face. |
| Moertl 2009 | Home‐based nurse care | Home‐based nurse care can reduce adverse events in people with chronic heart failure. High levels of natriuretic peptides in people with heart failure are predictors of death and hospitalisations. The study authors looked at whether high levels of these peptides can predict whether people with heart failure benefit from a home‐based nurse intervention. | The nurse checked for and, in co‐ordination with the treating physician, implemented guideline‐based medication (Remme 1997; Remme 2001). | At home visits, the nurse checked and recorded weight, recorded symptoms and signs of heart failure as well as heart rate and blood pressure, and organised and reviewed blood analyses on demand. The nurse also gave the patient education and self‐management skills. | Nurses who specialised in caring for people with heart failure provided the intervention. | The intervention was delivered individually and face‐to‐face. |
| Murray 2004 | Computerised care suggestions | Hypertension is associated with cardiovascular morbidity and mortality, but is difficult to control. Guidelines on hypertension are complicated and can become outdated quickly, so this study investigated the benefits of evidence‐based treatment for hypertension using a computerised system. | This study used the pharmacist intervention recording system, which was used to document all pharmaceutical care interventions (Overhage 1999). This system gave the pharmacist care suggestions, which they could pass on to the physician. The physician used an order writing workstation to write orders for drugs, tests, nursing activities, and consultations (McDonald 1999). The workstation gave the physician care suggestions for the treatment of hypertension. | The pharmacist intervention recording system was used by intervention pharmacists to receive care suggestions. The pharmacist could fill the prescription as written, discuss the suggestions with the participant and encourage discussions between the participant and physician, or contact the ordering physician. The physician intervention used an order‐writing workstation to write orders for drugs, tests, nursing activities and consultations and display care suggestions. All hypertension care suggestions were displayed as suggested orders along with possible actions and a brief explanation of the rationale for the suggestion. | Pharmacists and physicians provided the intervention. | The intervention was delivered individually and face‐to‐face. |
| Nabagiez 2013 | Home visits by physician assistants | Studies suggest that people who have undergone coronary artery bypass graft surgery benefit from a home intervention, but there are few studies of home visits by physicians or physician assistants. Therefore, this study examined the hospital readmissions of people who received home visits by physician assistants. | A physician assistant home care form/checklist was used to record all findings from the home visit. A copy of this form was provided in the paper. | Cardiothoracic physician assistants conducted home visits during which they performed a physical examination and reviewed the participant's medications. Adjustments were made to the participant's medications and new medications were prescribed as needed. The surgical wounds were examined and participant concerns were addressed. Prescriptions were written for antibiotics, blood work, or imaging studies. | Physician assistants provided the intervention. | The intervention was delivered individually and face‐to‐face. |
| Okamoto 2001 | Pharmacist‐managed hypertension clinic | Hypertension can be controlled, but this study investigated whether it can be managed at a reasonable cost with minimal adverse effects by pharmacists. | Sitting blood pressure was measured with a Datascope Accutorr automated sphygmomanometer (Datascope Corporation Montvale, NJ, USA). 2 readings were taken for each participant and the average of the 2 readings was recorded (Datascope Patient Monitoring 1996). | Participants were counselled by a pharmacist who told them that efforts would be made to decrease the number of antihypertensive drugs or alter their therapy by giving more appropriate or less expensive drugs to achieve similar or improved blood pressure control. The pharmacist determined the most appropriate antihypertensive regimen for each participant, ordered laboratory tests as needed, and provided education on nonpharmacological ways to control blood pressure. | Clinical pharmacists provided the intervention. | The intervention was delivered individually and face‐to‐face. |
| Olesen 2014 | Pharmacist medication review | Pharmacists work with participants in designing, implementing and monitoring therapeutic plans, but elderly people may have problems with adhering to their medication. This study looked at treatment adherence, as well as hospitalisations and mortality, in elderly people who received a home visit by a pharmacist along with telephone follow‐up. | Pharmacists adhered to a manual to deliver the intervention (Medication Review‐Managing Medicine Manual, Danmarks Apotekerforening, Pharmakon. Medicingennemgang 2004). This manual helps pharmacists identify and resolve drug‐related problems (Danmarks 2004). | Participants were visited at home by a pharmacist who examined the medicines list with regard to side‐effects, interactions and administration. The pharmacist tried to make the regime less complex, informed participants, and motivated adherence. | Pharmacists who had some practical experience or courses in medication review provided the intervention. | The intervention was delivered individually. It was conducted by telephone and face‐to‐face. |
| Pai 2009 | Pharmacist medication review | People with end‐stage renal disease take multiple drugs and experience multiple co morbidities, which places them at greater risk of drug‐related problems. This paper looked at the effects of a pharmacist‐led intervention on drug‐related problems and hospitalisations in ambulatory patients undergoing haemodialysis. | Drug‐related problems were recorded, evaluated and assigned to 10 possible categories (Hepler 1990). The drug‐related problems were also categorised into therapeutic drug classes and the outcome related to the drug‐related problem intervention was captured. | Participants assigned to pharmaceutical care had drug therapy reviews conducted by a nephrology‐trained pharmacist. The pharmacist conducted a participant interview, generated a drug therapy profile, identified and addressed drug‐related problems, and provided healthcare‐provider and participant education. The pharmacist also provided consultative services that focused on optimising drug therapy. | The clinical pharmacists who conducted the intervention were either nephrology‐trained or completing postdoctoral training in nephrology pharmacotherapy. | The intervention was delivered individually and face‐to‐face. |
| Roberts 2001 | Medication review, nurse education, and development of professional relationships | Pharmacist‐conducted medication reviews and nurse education about medication use may have an impact on drug use in nursing homes. This study looked at the effect of medication review and nurse education on mortality and hospitalisations in nursing homes. | Problem‐based educational sessions were provided to nurses and addressed basic geriatric pharmacology and some common problems in long‐term care. No referenced documentation is provided for these sessions. | The intervention introduced a new professional role to stakeholders with relationship building, nurse education, and a medication review by pharmacists. Professional contact between nursing home staff and pharmacists on issues such as drug policy and resident problems was conducted along with problem‐based educational sessions for nurses. These sessions addressed geriatric pharmacology and problems in long‐term care. The medication reviews highlighted adverse drug effects, ceasing or adding drugs, better use of specific drug therapy, non‐drug interventions, and adverse effect and drug response monitoring. | Clinical pharmacists delivered the intervention. | The intervention was delivered individually and in groups over the phone and face‐to‐face. |
| Rytter 2010 | Structured home visits by GP and nurse | Many hospital admissions are due to inappropriate medical treatment, and the discharge of fragile elderly patients is associated with a high risk of readmission. This study examined whether home visits by GPs and district nurses reduced the risk of readmission of discharged elderly patients. | The joint home visits were guided by an agenda. During the structured home visit the agenda included checking the discharge letter for recommended follow‐up, checking the need for adjustment of medication, checking if social and personal support was arranged, and checking the family’s medicine cabinet. This agenda was provided in the article. | There was a joint home visit by the GP and district nurse approximately one week after discharge from the hospital. 2 more contacts were conducted by the GP in the GP's clinic or as a home visit. These visits included checking the discharge letter, checking the need for adjustment of medication, checking if social and personal support was arranged, and checking the family's medicine cabinet. | GPs and district nurses provided the intervention. | The intervention was delivered individually and face‐to‐face. |
| Triller 2007 | Pharmacist medication reviews | Adverse drug events are frequently caused by cardiovascular drugs. Pharmacists can identify and resolve drug‐related problems for people at home and reduce re‐hospitalisation rates. This study investigated whether a pharmacist‐led intervention could reduce re‐hospitalisations and death in people with heart failure. | Using a predefined checklist, the pharmacist tried to reduce the use of inappropriate mediations, encourage smoking cessation, suggest improvements in the participant’s diet, and promote medication adherence, self‐monitoring, and vaccination. The checklist is not provided in the paper. | The pharmacist in the intervention group conducted an in‐home medication assessment and 2 follow‐up visits. This involved assessing and reviewing physician notes and laboratory test values and interacting with prescribers on behalf of the participants. The pharmacist catalogued all medications and interviewed the participant regarding medication use. | A clinical pharmacist, who had over 20 years of combined experience as a hospital and community pharmacist and had received a doctor of pharmacy degree and completed a 1‐year clinical residency in home care, provided the intervention. | The intervention was delivered individually and face‐to‐face. |
| Zermansky 2001 | Pharmacist medication review | Repeat prescribing is poorly managed in the UK, which puts people at risk. Pharmacists could review these prescriptions and reduce the pressure on GPs. This study tested whether pharmacists can review repeat prescriptions to reduce hospital admissions and deaths. | The process for reviewing repeat prescriptions involved discussing each condition with the participant and asking about symptoms (Lowe 2000). If clinical or pathological monitoring was due, the pharmacist directed the participant to the practice nurse or doctor. Participants with new clinical problems were referred to the doctor. | The pharmacists conducted a medication review during which they evaluated the therapeutic efficacy of each drug and the progress of the conditions being treated. Compliance, actual and potential adverse effects, interactions, and the participant’s understanding of the condition and its treatment were considered. The outcome of the review was a decision about the continuation of the treatment. | A pharmacist provided the medication review. | The intervention was delivered individually and face‐to‐face. |
| Zermansky 2006 | Pharmacist medication review | Elderly people take multiple medicines, which increases the risk of adverse drug events. Pharmacists can improve medicine management for elderly people in the community. In this study, the authors looked at whether a pharmacist‐led review would reduce hospitalisations and deaths among elderly people in nursing homes. | The clinical medication review (Lowe 2000), which was conducted by the pharmacist, comprised a review of the GP clinical record, and a consultation with the participant and carer. The pharmacist made recommendations and passed them on a written proforma to the GP for acceptance and recommendation. | The pharmacist conducted a medication review in which the pharmacist identified the drugs that were taken, identified the original indication for each drug, assessed adherence to medication, and identified unaddressed medical problems. They also considered the continuing need for each drug, identified side effects, identified drug interactions or contraindications, and considered costs. Finally, the pharmacist implemented and documented any changes. | The study pharmacist provided the intervention. | The intervention was delivered individually and face‐to‐face. |
