Community Pharmacist–Led Medication Reviews

Question

What is the current landscape regarding medication review programs in community settings across Canadian jurisdictions and select international locations (TBD)? What do others' medication review programs entail, how have they evolved over the years and have they demonstrated any impact/value.
What are the evidence-based policies, guidelines or best practices regarding medication review programs in community settings to ensure they achieve maximum intended impact (i.e., enhancing potential benefits & reducing potential risks associated with a patient's medications)?
What is the clinical utility of pharmacist-led medication reviews in the community setting? (e.g., reduced hospital admissions, deprescribing of medication(s), medication adherence, health markers or outcomes [e.g., blood pressure, HbA1c, LDL/HDL, INR]; and safety impacts such as death, adverse drug reactions)
What is the cost-effectiveness of pharmacist-led medication reviews in community settings versus no medication reviews? (e.g., cost per health benefit gained, cost per preventable adverse drug reaction, cost per disability adjusted life year avoided) Database/GreyLit search with a focus on Economics (Economic studies filter, etc.)
What is the evidence regarding patient perspectives on the use and value of medication review programs?

Community pharmacist–led medication reviews are widely used in Canada and internationally.
It has been shown that community pharmacist–led medication reviews can identify medication issues. Broadly speaking, pharmacists feel qualified to deliver this service and, from the few studies that measured patient satisfaction, patients find value in receiving a medication review in a community pharmacy.
In terms of patient and health system outcomes, community pharmacist–led medication reviews seem to have limited impact. Individuals living with defined chronic conditions, such as diabetes or hypertension, or those living with multiple chronic conditions seem most likely to benefit.
No studies of cost-effectiveness in the Canadian context were identified.
A variety of barriers that impact pharmacist-led medication reviews were identified in the literature, including: o limited communication between community pharmacists and prescribers resulting in pharmacists’ recommendations not being implemented o a lack of time on the part of pharmacists o challenges with patient selection.
Policy interventions that may help alleviate these barriers include: o incentivizing communication and collaboration between pharmacists and prescribers o reducing administrative burden o improving access to patient information o enhancing patient selection by incentivizing service provision for the most medically complex patients.