%0 Journal Article
%T Do Pharmacist-Led Prescribing and Deprescribing Improve Patient Outcomes Without Increasing Treatment Burden? A Systematic Review of Controlled Studies, 2017–2025
%A Thomas Weber
%A Priya Menon
%A Mohamed Al-Hassan
%J Annals of Pharmacy Practice and Pharmacotherapy
%@ 3062-4436
%D 2024
%V 4
%N 2
%R 10.51847/PAnfiyz88d
%P 149-160
%X Pharmacists increasingly undertake medication review, prescribing and deprescribing, but medication-level improvement does not necessarily establish patient benefit. Effects may depend on pharmacist prescribing authority, whether medication is initiated, modified or withdrawn, comparator intensity, outcome definition and the extent to which treatment burden is measured directly. To determine whether pharmacist-led prescribing and deprescribing improve patient-important outcomes without increasing treatment burden, and to identify the intervention and comparator conditions under which quantitative pooling is clinically interpretable. PubMed/MEDLINE-targeted searches covering pharmacist prescribing, deprescribing, medication review, medication reconciliation and controlled trials from 2017–2025 identified 57 records. Citation-chain and publisher verification identified five additional unique records. After removal of two duplicates, 60 records were screened; 26 reports underwent full-text assessment and 18 controlled studies were included. Outcomes were separated into medication exposure/prescribing quality, clinical benefit, medication harm, healthcare use, quality of life and treatment burden. RoB 2 informed risk-of-bias appraisal for randomized trials. Quantitative pooling was prespecified only for clinically compatible outcome families. Thirty-four records were excluded during title/abstract screening. Eight of 26 full texts were excluded, leaving 18 controlled studies. Pharmacist-led interventions more consistently improved medication-level outcomes than distal patient outcomes. D-PRESCRIBE increased targeted inappropriate-medication discontinuation from 12% to 43%. In CHIPPS, independent pharmacist prescribing reduced Drug Burden Index but did not significantly reduce falls. Other studies showed favorable disease-specific, medication-safety or regimen outcomes alongside null effects for hospitalization, adverse events or generic quality of life. Direct treatment-burden measurement was uncommon. No outcome family satisfied all prespecified criteria for a defensible new pooled estimate.Pharmacist-led prescribing and deprescribing can improve medication use, but medication change cannot be assumed to improve all patient-important outcomes or reduce treatment burden. Interpretation depends particularly on decision authority, intervention direction, comparator intensity, outcome construct and follow-up.
%U https://galaxypub.co/article/do-pharmacist-led-prescribing-and-deprescribing-improve-patient-outcomes-without-increasing-treatmen-zineomwojetvmrd