The Impact of Pharmacist Interventions on Quality Use of Medicines, Quality of Life, and Health Outcomes in People with Dementia and/or Cognitive Impairment: A Systematic Review

Article type: Research Article

Authors: Nguyen, Tuan Anh^{a; b; *} | Gilmartin-Thomas, Julia^c | Tan, Edwin Chin Kang^{d; e; f} | Kalisch-Ellett, Lisa^a | Eshetie, Tesfahun^a | Gillam, Marianne^a | Reeve, Emily^{g; h; i}

Affiliations: [a] Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia | [b] Health Strategy and Policy Institute, Ministry of Health of Vietnam | [c] Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Parkville, Australia | [d] The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, NSW, Australia | [e] Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia | [f] Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden | [g] NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia | [h] Geriatric Medicine Research and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, NS, Canada | [i] College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada

Correspondence: [*] Correspondence to: Tuan Anh Nguyen, BPharm, MPharm PhD, Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA 5000, Australia. Tel.: +61 8 8302 2817; E-mail: [email protected].

Abstract: Background:Medication use in people with dementia and/or cognitive impairment (PWD/CI) is challenging. As medication experts, pharmacists have an important role in improving care of this vulnerable population. Objective:Systematically review evidence for the effectiveness of pharmacist-led interventions on quality use of medicines, quality of life, and health outcomes of PWD/CI. Methods:A systematic review was conducted using MEDLINE, EMBASE, PsycINFO, Allied and Complementary Medicine (AMED) and Cumulative index to Nursing and Allied Health Literature (CINAHL) databases from conception to 20 March 2017. Full articles published in English were included. Data were synthesized using a narrative approach. Results:Nine studies were eligible for inclusion. All studies were from high-income countries and assessed pharmacist-led medication management services. There was great variability in the content and focus of services described and outcomes reported. Pharmacists were found to provide a number of cognitive services including medication reconciliation, medication review, and medication adherence services. These services were generally effective with regards to improving quality use of medicines and health outcomes for PWD/CI and their caregivers, and for saving costs to the healthcare system. Pharmacist-led medication and dementia consultation services may also improve caregiver understanding of dementia and the different aspects of pharmacotherapy, thus improving medication adherence. Conclusion:Emerging evidence suggests that pharmacist-led medication management services for PWD/CI may improve outcomes. Future research should confirm these findings using more robust study designs and explore additional roles that pharmacists could undertake in the pursuit of supporting PWD/CI.

Keywords: Cognitive impairment, dementia, health outcome, impact, intervention, pharmacist, quality of life, role, systematic review

DOI: 10.3233/JAD-190162

Journal: Journal of Alzheimer's Disease, vol. 71, no. 1, pp. 83-96, 2019