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

Abstract

Introduction: Excessive polypharmacy, which is defined as the use of ten medications or more, poses considerable challenges regarding patient health and healthcare resources. Individuals who exhibit excessive polypharmacy are predisposed to adverse drug effects, drug interactions, and non-adherence, which can result in increased hospitalization, emergency room visits, and mortality. Given their expertise in medication management, pharmacists are uniquely positioned to address the risks associated with excessive medication use. Therefore, exploring their role in this phenomenon across their various fields of practice is essential.

Aim: The aim of this review was to summarize the existing literature on the role of pharmacists in addressing excessive polypharmacy in different care settings and to highlight areas where more research is needed.

Method: A scoping review was conducted by adopting Arksey and O'Malley's methodological framework, along with subsequent enhancements implemented by Levac et al. It was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search was conducted across five databases: MEDLINE, EMBASE, PubMed, CINAHL and Cochrane CENTRAL from their inception until June 2024. Covidence was used for data selection and extraction. The results were analyzed using narrative synthesis.

Results: We identified 5236 articles, of which 19 were included. All studies were available in English and were conducted in high-income countries with the majority (84%) being published after 2019. The interventions were carried out in primary care clinics, hospitals, home care, and long-term care facilities, but none of the studies were conducted in community pharmacies. The analysis identified four predominant roles: performing medication reconciliation during care transitions, assessing medication appropriateness, raising awareness among prescribing healthcare professionals, and ensuring patient follow-up and monitoring. These roles emphasized collaboration between patients and interprofessional teams and were supported by various polypharmacy management tools.

Conclusion: This review's results highlight pharmacists' various roles in managing excessive polypharmacy across care settings. The scope of practice, physical proximity to other health professionals, expertise, higher qualifications and/or additional training all influenced these roles.