Background Non-adherence to medication regimens is a major cause of nursing home placement of frail older adults. Approximately 30 percent of hospital admissions of older adults are drug related, with more than 11 percent attributed to medication non-adherence and 10–17 percent related to adverse drug reactions. The aim of this systematic review was to determine whether community pharmacist home visits improve health outcomes for frail elderly and vulnerable populations.
Methods Systematic searches were conducted in 11 electronic databases from inception to July 2015. Reference lists of all included studies and forward citation searching were conducted. Eligible participants included the frail elderly, individuals with multi-morbidity and complex health needs, or those recently discharged from hospital with medication issues. Randomised controlled trials that were described as a home visit service by community pharmacists were eligible for inclusion. Primary outcomes of interest were hospital and nursing home admissions, mortality, quality of life and medication adherence. Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. The Cochrane risk of bias tool was used for quality appraisal. Random-effects meta-analyses were performed.
Results The electronic searches found a total of 2405 results, and after title and abstract screening, 137 full texts were retrieved for closer examination. 11 randomised controlled trials (reported in 14 articles) met eligibility criteria and were included in the final review. In total, 3251 participants were enrolled across the trials, with participants on multiple medications and/or chronic health issues about to be discharged from hospital (n = 8 trials), or older adults (>55 years) living in the community taking multiple medications and/or considered at risk of medication problems (n = 3 trials). Risk of bias was generally low. Seven trials were able to be pooled for analysis of the effects on hospital admissions and mortality. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 0.99 (95% CI: 0.79 to 1.25, p = 0.96; 7 studies), or for death (RR of 0.99 (95% CI: 0.79 to 1.25, p = 0.96; 7 studies). There was also no consistent evidence of effect on quality of life or on adherence or medication issues.
Discussion This systematic review of eleven randomised controlled trials found little evidence of effectiveness for home visits by community pharmacists for vulnerable populations. Future research exploring participant and provider views on home visits involved may help to understand the limited effectiveness observed and guide future research.