BACKGROUND Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting. REVIEW METHODS To determine the effectiveness of pharmacist home visits for individuals at risk of medication-related problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data. RESULTS Twelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I2 = 69.0%, p = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I2 = 0%, p = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge. CONCLUSION A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes.

中文翻译：

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对有药物相关问题风险的个体的药剂师上门服务的有效性：随机对照试验的系统评价和荟萃分析。

背景技术药物管理不善是脆弱的老年人入院和疗养院安置的主要原因。社区药剂师进行的药物审查旨在最大程度地提高治疗效果，同时最大程度地减少伤害。药剂师主导的用药审查一直是一些系统审查的重点，但没有一个集中在家庭环境上。审查方法为了确定对有药物相关问题风险的个人进行药剂师上门检查的有效性，我们进行了系统的审查和随机对照试验（RCT）的荟萃分析。从开始到2018年12月，共检索了13个数据库。还对纳入研究进行了前后引用。由两名审稿人对文章进行独立筛选。药师对有药物相关问题风险的个人进行的家庭访问的随机对照研究符合纳入条件。由一位审阅者进行数据提取和质量评估，并由另一位审阅者进行检查。在允许足够的数据并且叙述性综合总结了所有剩余数据的情况下，进行了随机效应荟萃分析。结果纳入12项RCT（共15篇文章），涉及3410名参与者。家访的频率，内容和目的相差很大。来自八项试验的数据适合于对入院率和死亡率的影响进行荟萃分析，来自三项试验的对生活质量的影响。总体而言，没有证据表明住院人数减少（风险比（RR）为1.01（95％CI从0.86降至1.20，I2 = 69.0％，p = 0.89；8项研究（2314名参与者））或死亡率（RR为1.01（95％CI 0.81至1.26，I2 = 0％，p = 0.94; 8项研究，2314名参与者））。没有一致的证据表明对生活质量，药物依从性或知识有影响。结论对十二项RCT进行的系统评价评估了药剂师上门检查对有药物相关问题风险的个体的影响，但未发现对入院率或死亡率有影响的证据，而对生活质量影响的证据有限。未来的研究应侧重于使用更可靠的方法来评估相关结果。结论对十二项RCT进行的系统评价评估了药剂师上门检查对有药物相关问题风险的个体的影响，但未发现对入院率或死亡率有影响的证据，而对生活质量影响的证据有限。未来的研究应侧重于使用更可靠的方法来评估相关结果。结论对十二项RCT进行的系统评价评估了药剂师上门检查对有药物相关问题风险的个体的影响，但未发现对入院率或死亡率有影响的证据，而对生活质量影响的证据有限。未来的研究应侧重于使用更可靠的方法来评估相关结果。