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The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: a protocol for a systematic review [version 2; peer review: 2 approved]

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journal contribution
posted on 20.11.2020, 11:11 by Aisling Croke, Oscar James, Barbara Clyne, Frank Moriarty, Karen Cardwell, Susan Smith

Introduction: Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners. Pharmacists may improve management and outcomes for patients with polypharmacy. This systematic review aims to examine the clinical and cost-effectiveness of pharmacist interventions to optimise prescribing and improve health outcomes in patients with polypharmacy in primary care settings.

Methods: The review will be reported using the PRISMA guidelines. A comprehensive search of 10 databases from inception to present, with no language restrictions will be conducted. Studies will be included where they evaluate the clinical or cost-effectiveness of a clinical pharmacist in primary care on potentially inappropriate prescriptions using validated indicators and number of medicines. Secondary outcomes will include health related quality of life measures, health service utilisation, clinical outcomes and data relating to cost effectiveness. Randomised controlled trials, non-randomised controlled trials, controlled before-after, interrupted-time-series and health economic studies will be eligible for inclusion.

Titles, abstracts and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standard form. Risk of bias in all included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria. Economic studies will be assessed using the Consensus Health Economic Criteria (CHEC) list as per the Cochrane Handbook for critical appraisal of methodological quality. A narrative synthesis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Where data support quantitative synthesis, a meta-analysis will be performed.

Discussion: This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group. This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity.

PROSPERO Registration: CRD42019139679 (28/08/19)

Funding

Health Research Board Ireland (CDA-2018-003)

History

Associated research data files

Associated files can be found at https://osf.io/38cu5

Comments

The original article is available at https://hrbopenresearch.org

Published Citation

Croke A, James O, Clyne B, Moriarty F, Cardwell K, Smith SM. The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: a protocol for a systematic review. HRB Open Research. 2020;2:32.

Publication Date

12 March 2020

PubMed ID

32296750

Department/Unit

  • General Practice

Research Area

  • Population Health and Health Services

Publisher

HRB Open Research

Version

  • Published Version (Version of Record)

Exports