Contexts influencing the MR process and outcomes
| Context identified from the literature as having potential to influence participation | ||
| Context | Description | |
| Broadly applicable to medication review | Awareness and knowledge of MR programmes and referral pathways by HCPs | Policies, care models and practices promoting the existence of pharmacist-conducted MR programmes determine HCPs’ awareness of the programme and knowledge of how and who to refer for a medication review (MR).42 49 71 79 85
Referral pathways were established when existing MR programmes are leveraged or extended for MR after discharge18 19 50 51 54 65 76 and/or a triaging system is in place.53 57 |
| Patients’ experience and attitudes to pharmacists’ clinical role | Patients have varying experiences of pharmacists exercising their clinical role.36 37 74 77 | |
| System and organisational structures support MR and facilitate role integration | When postdischarge MR programmes were introduced de novo pharmacists only slowly integrated them into their practice or business.42 86
Postdischarge MR were implemented as variations of existing programmes, for example, Comprehensive Medication Review, Medication Therapy Management in the USA or Home Medicines Review in Australia.18 19 21 53 60 78 85 87 | |
| Location of MR appointment | Most MR were performed in a community pharmacy (CP).18–21 35–41 50 71 86
Several studies where MR was performed in a CP screened out patients who could not access the CP.38–41 50 72 74 Patients were visited at home.17 22 23 46 47 49 51–53 57–59 66 MR was performed in a physician’s practice.45 48 | |
| Specific to postdischarge MR | Location and timing of patient recruitment for participation | Patients are approached and recruited to an MR programme while in hospital and preparing for discharge.17–20 22 35 41 43 49 59 66 78 79 86 88
Patients receive information about MR while in hospital and are recruited before or when they are visiting their CP or before they visit their doctor.40 48 89 Planning and recruitment for MR occurs at a distance from the professional providing MR, who is not aware that a patient left hospital.34 38 39 42–44 72 |
| Postdischarge environment, being back home | Contact and engagement with patients was difficult to establish once they returned home.18–20 41 50 75
Patients were asked to organise their appointment once they returned home.20 37 40 41 43 Patients declined to attend an MR appointment.18–20 35 40 41 50 72 74 75 | |
| Contexts identified from the literature as having potential to influence MR process and outcomes | ||
| Broadly applicable to MR | Information available to pharmacist before and during the MR | The pharmacist has access to comprehensive clinical information provided by the hospital17 19 and/or a referring primary care provider (eg, doctor)53 60 65 and/or access to an electronic health record.18 45 47 48 51 52
Pharmacist has only access to discharge medication list and/or summary.20 23 35 37 38 43 44 49 57 58 72 |
| Regulations, standards and funding models guiding MR | These determine the extent and expectations of pharmacists’ involvement and scope of practice. MR is expected to be mainly an assessment of MRP, which the pharmacist documents and/or communicates to other HCPs (eg, the patient’s doctor, community pharmacy).23 57 59 Pharmacist addresses and resolves issues with patient.17–19 Pharmacist identifies and resolves MRPs (eg, dose adjustments) or follows up with other HCPs who can resolve them.17–19 66 | |
| Specific to postdischarge MR | Professional communication collaboration, coordination and networks | A network of HCPs coordinates the MR, for example, scheduling of an appointment is not left to the patient, appointments are made, doctors are prompted to refer, records are shared. This could be through a hospital pharmacist, care-navigator (primary care), discharge coordinator (in hospital), GP, community pharmacist.17–19 45 46 48 53 55 56 59 60 65 67 87 90
Pharmacists who are tasked to perform MR are informed that patients have been discharged.18–20 23 35 46 47 49 50 57–59 86 Pharmacists who are tasked to perform MR are not informed that patients have been discharged.39 42 44 71 |
GP, general practitioner; HCP, healthcare professional; MR, medication reviews; MRP, problem.