Effectiveness of Pharmacist-Led Interventions on Medication Use and Related Health Outcomes in Patients With Alzheimer's Disease and Related Dementias: A Systematic Review

OBJECTIVES: To assess the effects of pharmacist-led interventions on medication use and related health outcomes in older adults with Alzheimer's disease and related dementias (ADRD) using published literature.

METHODS: Four databases, including Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, PubMed, and EMBASE, as well as the ClinicalTrials.gov registry, were systematically searched for articles published in English language from inception to April 16, 2023. Search terms included "dementia”, "amentia”, "Alzheimer's Disease”, "Alzheimer's”, "pharmacist”, and "pharmacists”. Full-text articles that investigated the impact of pharmacist-led interventions on medication utilization and related health outcomes in older patients with ADRD were included during abstract and full-text review. The National Institutes of Health (NIH) Quality Assessment Tools were used to rate the quality of included studies based on study design. Two reviewers independently assessed studies for inclusion, extracted data, and assessed the risk of bias of the included studies.

RESULTS: Among a total of 3607 records screened, 25 full-text reports that met the inclusion criteria were included in this systematic review. There were 4 controlled intervention studies, 1 retrospective cohort study, 5 randomized controlled trials (two trials produced 4 reports), and 11 pre-post studies with no control group. Pharmacist-led interventions included medication reconciliations and reviews, counseling for patients and their caregivers, patient monitoring, and recommendations to other healthcare providers. Overall, these interventions were effective in reducing potentially inappropriate medication use, improving the appropriateness of anticholinergic and psychotropic medications, and reducing drug-related adverse events. However, the effects of pharmacist-led interventions on improving adherence and persistence to treatment, enhancing patients' quality of life, and reducing emergency department visits were inconsistent. Overall, 6 reports were rated "poor”, 12 were "fair”, and 7 were "good” quality.

CONCLUSIONS: Pharmacist-led interventions show effectiveness in improving appropriateness of certain medication use among older adults with ADRD.