Development of a Community Pharmacist-Led Medication Review Service: Design, Implementation, and Evaluation

Thesis Abstract

This study addresses the persistent challenges of suboptimal medication management in community settings, including polypharmacy risks, adverse drug events, and inadequate patient engagement with medication review processes. The aim is to design, implement, and evaluate a Community Pharmacist-Led Medication Review Service (CPLMRS) that integrates patient-centered care with evidence-based risk stratification to optimize therapeutic outcomes. Specific objectives are to (1) develop a standardized, patient-tailored medication review protocol suitable for community pharmacies; (2) implement the protocol across 12 community pharmacy sites over a six-month pilot; (3) assess process indicators such as fidelity to the protocol and pharmacist time allocation; (4) evaluate clinical outcomes including blood pressure control, glycemic indices, lipid levels, and polypharmacy burden; (5) examine patient-reported outcomes, including medication adherence, satisfaction, and health-related quality of life; and (6) explore barriers and enablers to integration of CPLMRS within routine pharmacy practice using a theoretical framework. A mixed-methods design is employed, drawing on pragmatism to maximize practical relevance. The study uses the Consolidated Framework for Implementation Research (CFIR) to guide implementation, and Rogers’ diffusion of innovations theory to interpret adoption dynamics. The population comprises adults aged 40–85 years who receive prescriptions through participating community pharmacies in a metropolitan region. A sample of 600 eligible patients will be recruited, with 300 allocated to the CPLMRS intervention and 300 to usual care in a quasi-experimental, controlled before-and-after design. Pharmacists (n=24) will receive targeted training in medication reconciliation, risk assessment, and patient counseling; a pharmacist facilitator manual will ensure standardized delivery. Data collection instruments include (i) a structured Medication Review Instrument capturing drug appropriateness, potential drug–drug interactions, and deprescribing opportunities; (ii) validated patient surveys—Medication Adherence Report Scale (MARS-5), the EQ-5D-5L for quality of life, and a satisfaction questionnaire; (iii) clinical metrics extracted from patient medical records (systolic/diastolic blood pressure, HbA1c, total cholesterol, triglycerides, and drug count). Data collection occurs at baseline, immediately post-intervention (6 months), and follow-up at 12 months for clinical and adherence outcomes; process data are captured through audit trails, time-motion studies, and pharmacist interviews. Quantitative analyses involve descriptive statistics and inferential tests. Primary outcomes include changes in the number of potentially inappropriate medicines, polypharmacy burden (defined as ?5 chronic medications), and composite clinical control indicators (blood pressure, HbA1c, lipid levels). Between-group comparisons utilize mixed-effects linear and logistic regression to adjust for covariates (age, sex, comorbidity index), with clustering by site. Mediation analyses explore whether improved adherence mediates clinical outcomes. Qualitative data from semi-structured interviews with patients and pharmacists will be analyzed using thematic analysis, with coding guided by CFIR constructs. Triangulation will integrate quantitative and qualitative findings to elucidate mechanisms of action and contextual factors affecting implementation outcomes. A nested process evaluation will document fidelity, reach, and sustainability indicators. Expected findings anticipate that CPLMRS will reduce polypharmacy burden and improve clinical indicators, particularly among high-risk subgroups (patients with hypertension and dyslipidemia). It is hypothesized that higher fidelity to the review protocol, robust pharmacist training, and supportive workflow integration will correlate with greater improvements in adherence and patient-reported outcomes. The study is anticipated to reveal important barriers—time constraints, reimbursement uncertainties, and informational gaps for patients—and enablers such as structured documentation, interprofessional communication, and patient engagement strategies. The contribution to knowledge includes operationalizing a scalable, evidence-based CPLMRS model for community pharmacies, evidence of its impact on clinical and patient-centered outcomes, and a theory-driven understanding of determinants of successful implementation validated by CFIR and diffusion theory. The main conclusion is that a pharmacist-led, standardized medication review embedded within routine community pharmacy practice can meaningfully reduce inappropriate polypharmacy and enhance clinical control while improving patient experiences; the recommendations emphasize policy support for reimbursement, integration with primary care teams, and ongoing training to sustain fidelity and impact. Policy and practice implications point toward adoptable frameworks for national rollout, with iterative refinement based on continuous quality improvement and extended follow-up to assess long-term outcomes.