%0 Journal Article
%T Which Components of Pharmacist-Led Medication Optimization Change Hard Clinical Outcomes? A Mechanism-Sensitive Systematic Review of Comparator Fidelity and Outcome Proximity, 2017–2024
%A Laura Fitzgerald
%A Thomas Andersen
%A Aisha Bello
%A Kenji Nakamura
%J Annals of Pharmacy Practice and Pharmacotherapy
%@ 3062-4436
%D 2023
%V 3
%N 2
%R 10.51847/kTImvhT0Jn
%P 136-151
%X Pharmacist-led medication optimization encompasses interventions that differ in review intensity, patient involvement, prescriber collaboration, follow-up, and continuity across care settings. Improvements in prescribing processes are frequently reported, but effects on medication-related harm, unscheduled healthcare use, readmission, and mortality are less consistent. Interpretation is further complicated when control groups receive overlapping medication-management activities and when successful recommendations do not lead to actual treatment modification. To determine which components of pharmacist-led medication optimization are associated with hard clinical outcomes and to examine how comparator fidelity, achieved treatment modification, and outcome proximity alter interpretation of apparently positive or null intervention effects. A systematic review of controlled intervention studies published from 2017 through 2024 was conducted using bibliographic, journal/publisher, and citation-chain searches. Eligible direct-synthesis studies evaluated pharmacist-led or pharmacist-co-led medication optimization and reported at least one patient-important clinical endpoint; co-reported intervention processes, implemented treatment changes, and intermediate medication outcomes were extracted to examine the pathway to those endpoints. Intervention components, actual comparator content, treatment modification, and outcome proximity were extracted separately. Risk-of-bias judgments were assigned only when the reported methodological information supported them. Heterogeneous evidence was synthesized without statistical pooling. Seventy-six records were identified, 15 duplicate or alternate records were removed, and 61 unique records were screened. Twenty-eight records were excluded at title/abstract screening; 33 reports were retrieved and underwent full-text assessment. Nineteen full-text reports were excluded, leaving 14 unique controlled studies in the qualitative synthesis. Interventions ranged from medication reconciliation or one-time medication review to longitudinal, multicomponent programmes spanning discharge and follow-up. Hard-outcome benefit was not consistently related to the presence of medication review itself. Positive findings occurred in some high-contrast integrated interventions, whereas several intensive programmes were null despite medication changes or reductions in inappropriate prescribing. Comparator groups varied from routine care with little explicit medication optimization to active medication reconciliation, pharmacist input, or medication education. Pharmacist-led medication optimization cannot be interpreted as a uniform exposure. The evidence supports a conditional interpretation in which component composition, the incremental contrast over actual comparator care, successful implementation of medication changes, and distance to the measured clinical endpoint jointly influence observed outcomes. Available multicomponent studies rarely permit causal attribution to individual pharmacist activities.
%U https://galaxypub.co/article/which-components-of-pharmacist-led-medication-optimization-change-hard-clinical-outcomes-a-mechanis-pqkeqcgzke0kela