A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why?

Luetsch, Karen, Rowett, Debra and Twigg, Michael (2020) A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why? BMJ Quality and Safety. ISSN 2044-5415

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Background: Medication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes or not. Objective: A realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital. Methods: The realist synthesis was performed in accord with RAMESES reporting standards. An initial program theory informed a systematic literature search of data bases (PubMed, Embase, CINAHL, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms. Results: The synthesis identified nine contexts in which ten mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care post-discharge. For a medication review to take place these include trust patients have in healthcare professionals, their health care priorities post-discharge, capacity to participate, perceptions of benefit and effort and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients. Conclusions: Medication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, coordination and collaboration between healthcare professionals and trust are established and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform post discharge medication review service models.

Item Type: Article
Faculty \ School: Faculty of Science > School of Pharmacy
Depositing User: LivePure Connector
Date Deposited: 06 Oct 2020 23:58
Last Modified: 17 Jan 2021 00:50
URI: https://ueaeprints.uea.ac.uk/id/eprint/77142
DOI: 10.1136/bmjqs-2020-011418

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