Helen C. Gallagher
University College Dublin, Ireland
Helen C. Gallagher B.Sc. (Hons), B. Pharm., M.Pharm., Ph.D., MPSI, holds degrees in Pharmacology and Pharmacy from University College Dublin, Trinity College Dublin & The Royal College of Surgeons in Ireland. She is a Lecturer in the School of Medicine and Medical Science, University College Dublin, Ireland, and works part-time as a Community Pharmacist. Her main research interests are in the areas of anaesthetics/ pain medicine, neuropharmacology & pharmaceutical care. She is currently the recipient of a Cochrane Fellowship from the Health Research Board of Ireland and a member of the Cochrane Pain, Palliative & Supportive Care Review Group.
Regular medication review is recommended for elderly patients and those on multiple drug therapy. Th e overall objective of such reviews is to ensure that drugs are prescribed and used appropriately and that patients are deriving maximum benefit from their drug regimes. As such, medication review requires knowledge of a patient's medical problems that are treatable with medicines, the medicines that are prescribed for those problems, and an appreciation of the patient's level of understanding and adherence with that medicine. It is increasingly recognised that pharmacists should be involved in the process of medication review if the patient is to receive optimal pharmaceutical care. Th ere are numerous examples of clinical scenarios in which pharmacist-led medication review has improved patient adherence patterns and clinical outcomes. Overall, it appears that the professional expertise of pharmacists in conducting medication reviews can be demonstrated most clearly in discrete disease areas/clinical scenarios. Well-designed, randomized studies in which outcome measures are rather narrowly defined (eg blood pressure or blood sugar indices) appear to be more likely to indicate positive benefits of medication review, whereas generalised outcomes such as mortality, morbidity and quality of life appear more resistant to such interventions. This has provoked serious debate in the literature, much of which pits the professions of pharmacy and medicine against each other. Here, evidence for the benefit of medication reviews by pharmacists is reviewed and discussed with the aim of identifying confounding factors that are currently hindering progress in this important area of pharmacy practice.