Pharmacists’ role in interventions addressing excessive polypharmacy: a scoping review
Notice bibliographique
Résumé
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.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,028 | 0,114 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,006 | 0,008 |
| Bibliométrie | 0,015 | 0,013 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,006 | 0,005 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,004 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».