Pharmacist-led medication reviews: A scoping review of systematic reviews

Miriam Craske; Wendy Hardeman; Nicholas Steel; Michael James Twigg

doi:10.1371/journal.pone.0309729

Peer Review History

Original SubmissionOctober 17, 2023
23 Nov 2023 Decision Letter - Nasser Hadal Alotaibi, Editor PONE-D-23-33977Pharmacist-led medication reviews: A scoping review of systematic reviewsPLOS ONE Dear Dr. Craske, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 07 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). 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You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript titled as Pharmacist-led medication reviews: A Scoping Review of systematic reviews submitted to PLOS ONE with manuscript number PONE-D-23-33977 for possible publication is not suitable for the publication as such due to following points. Accepted after the following MINOR revisions. General Comments: The manuscript provides a comprehensive overview of pharmacist-led medication reviews. The structure and content are well-organized, covering the most important aspects of the literature. However, the following critical points require further attention to enhance the validity and impact of the findings. • The Scoping review method was outlined but the manuscript would benefit from more explicit details regarding the search strategy, inclusion and exclusion criteria, selection process, and data extraction process. This would significantly bolster the credibility and transparency of this manuscript’s findings. • It is important to clearly define and explain the components of the medication review interventions investigated in the systematic reviews. The absence of this information limits the understanding of the elements contributing to outcomes. • A significant part of the systematic reviews received low AMSTAR 2 ratings, which raises concerns about their methodological quality. This directly impacts the reliability and trustworthiness of the conclusions drawn from these reviews. This can be addressed by discussing the potential reasons for such poor ratings or by suggesting strategies for improving the quality of the reviews. • The manuscript highlights gaps and challenges in the reviews (e.g., interpretation of results due to heterogeneity among interventions and outcomes) but doesn’t suggest a strategy to address them. Suggestions for future research directions and methodologies to overcome such issues can enhance the impact of the manuscript. • The manuscript also identifies the lack of consistent reporting and standardization across reviews as a major limitation but does not provide detailed suggestions on how this standardization can be achieved. Citing the NICE and PCNE definitions is a good start, but more emphasis on the necessity for establishing standardized reporting is required. • In the conclusion the uncertainty of the evidence is highlighted, however, it would be beneficial to provide clear implications for practice and policy. i.e. How can these findings guide the implementation of pharmacist-led medication review in real-life scenarios? What are the practical implications for healthcare professionals, policymakers, and patients? The manuscript effectively reviews the existing literature on the topic. Incorporation of the above-mentioned suggestions will strengthen the manuscript and refine the review’s contributions to the field and future research and practice. Reviewer #2: Thank you for addressing this important topic. Here are some specific comments and suggestions for improvement: Abstract: • In the background section, consider providing more context for the importance of "medication" reviews (note the typo in "edication"). • In the aim section, it would be beneficial to be more specific by stating that the review aims to examine the "extent, range, and quality" of systematic reviews on pharmacist-led medication reviews. • In the methodology section, consider upgrading by providing detailed information on the databases searched, inclusion/exclusion criteria, and the criteria used to assess the quality of the systematic reviews. • In the conclusion section, it would be more impactful to highlight the main takeaways from the review and emphasize the need for further research in this area. Introduction: • The introduction is clear and effectively sets the stage for the importance of medication reviews. • Consider incorporating a more explicit and succinct statement of the research question or objective to enhance clarity. Methodology: • Positive feedback is provided for the methodology, indicating satisfaction with the methods used. Overall Impression: • The paper is well-researched and provides a thorough examination of existing systematic reviews on pharmacist-led medication reviews. • While the language is generally clear, attention to detail in sentence construction and grammar is recommended. Recommendations: • Implement the suggested improvements in the abstract, ensuring clarity on the aim, methodology, and conclusion. • In the introduction, incorporate a more explicit statement of the research question or objective. • Pay close attention to detail in sentence construction and grammar throughout the paper. Thank you for your efforts, and I look forward to seeing the revisions. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Sajidur Rahman Akash ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0309729.r001
Revision 1
6 May 2024 Author Response In response to the journal requirements highlighted, 1. The manuscript has been updated to reflect PLOS ONE’S style requirements 2. Funding information has been removed from the manuscript 3. The title page has been included within in the main document 4. Figures have been added to the manuscript with supplementary files as “supporting information” 5. Captions for the supporting information have been updated to reflect style requirements. 6. The reference list has been reviewed. Reference [1], Network Contract Direct Enhanced Service: Contract specification 2019/20 has been replaced with the current updated Network Contract Directed Enhanced Service Contract specification 2023/24-PCN Requirements and Entitlements. Reviewer One The manuscript provides a comprehensive overview of pharmacist-led medication reviews. The structure and content are well-organized, covering the most important aspects of the literature. Thank you However, the following critical points require further attention to enhance the validity and impact of the findings. • The Scoping review method was outlined but the manuscript would benefit from more explicit details regarding the search strategy, inclusion and exclusion criteria, selection process, and data extraction process. This would significantly bolster the credibility and transparency of this manuscript’s findings. The research strategy for the scoping review is described in S1 file. However, we recognise that the inclusion and exclusion criteria were difficult to find. Therefore, we have made this clearer. (See lines 98-111) The inclusion and exclusion criteria for the systematic reviews is as follows: • All adult (≥18 years) recipients of medication reviews regardless of the setting or medical history. • Participants received a medication review. To be included, at least 50% of the primary studies must have utilised a medication review as the intervention. • Results and/or discussion make specific reference to the implementation and impact of medication review. • Reviews reported all outcomes. • Systematic reviews containing all types of studies. Reviews were excluded if: • full text was not available. • pharmacists did not have a leading role in delivering the interventions. • not available in the English language; time and financial constraints did not allow for translation from other languages. • It is important to clearly define and explain the components of the medication review interventions investigated in the systematic reviews. The absence of this information limits the understanding of the elements contributing to outcomes. Thank you for bringing this to our attention. Some additional information has been added to lines 117-124 for clarity “The components of interest of the medication review were type of review (PCNE level 2 or 3[9]), mode of delivery (e.g. face-to-face, telephone), setting (e.g. community pharmacy, hospital), duration (how long), intensity (how often), and collaboration with other healthcare professionals. A PCNE level 2 reviews medication history available in the pharmacy alongside information from clinical records or obtained directly from the patient. A level 3 review utilises information obtained from medication history, clinical records and directly from the patient. The main results at the systematic review level were summarised and reported as evidence of no effect, uncertain effect, or evidence of effect.” • A significant part of the systematic reviews received low AMSTAR 2 ratings, which raises concerns about their methodological quality. This directly impacts the reliability and trustworthiness of the conclusions drawn from these reviews. This can be addressed by discussing the potential reasons for such poor ratings or by suggesting strategies for improving the quality of the reviews. Agree. The quality of the reported studies does impact on the reliability of the conclusions. Potential reasons for poor ratings have been added from line 149 “Seventeen of the 24 reviews were rated as critically low confidence in the methods and results, two as low, three as moderate, and two as high. Seventeen reviews did not report a registered protocol and fourteen did not provide sufficient justification of the exclusion of studies; these are critical domains. Where one critical flaw is observed, these reviews can only be low confidence. Where more than one critical flaw was observed, these reviews were assessed as critically low. If authors had indicated a published protocol and included more detailed description of excluded studies, overall confidence in results would have been greater. The full AMSTAR 2 assessment is reported in S3 table.” • The manuscript highlights gaps and challenges in the reviews (e.g., interpretation of results due to heterogeneity among interventions and outcomes) but doesn’t suggest a strategy to address them. Suggestions for future research directions and methodologies to overcome such issues can enhance the impact of the manuscript. Consideration of future research direction has been added, lines 331-343 “Future systematic reviews could reduce the challenges of interpretation of the results due heterogeneity of the intervention by having more restrictive inclusion criteria, for example, limiting the included studies to specific outcomes and validated measures, such as health-related quality of life, medicines appropriateness, or to those where there a good description of the intervention. There is also an opportunity for a future systematic review to focus on the different components/attributes of medication reviews and determine which of these lead to particular outcomes. • The manuscript also identifies the lack of consistent reporting and standardization across reviews as a major limitation but does not provide detailed suggestions on how this standardization can be achieved. Citing the NICE and PCNE definitions is a good start, but more emphasis on the necessity for establishing standardized reporting is required. Additional information has been added, lines 337-343 “ A rapid review of evidence of clinical pharmacy services in the UK reported that implementation of medication use reviews was unstandardised, which led to a disparity in delivery [41]. This review concluded that the evidence for the cost-effectiveness of the review was lacking. This rapid review reinforces the conclusion of this scoping review, that there is a need to standardise reporting of interventions in order that coherent conclusions can be drawn about the effectiveness of medication reviews. This will then aid policy makers and practitioners in implementing medication reviews which are more likely to yield better outcomes for patients.” • In the conclusion the uncertainty of the evidence is highlighted, however, it would be beneficial to provide clear implications for practice and policy. i.e. How can these findings guide the implementation of pharmacist-led medication review in real-life scenarios? What are the practical implications for healthcare professionals, policymakers, and patients? Thank you for identifying this. This has been addressed in the response to the previous comment. The manuscript effectively reviews the existing literature on the topic. Incorporation of the above-mentioned suggestions will strengthen the manuscript and refine the review’s contributions to the field and future research and practice. Reviewer Two Abstract: • In the background section, consider providing more context for the importance of "medication" reviews (note the typo in "edication"). • In the aim section, it would be beneficial to be more specific by stating that the review aims to examine the "extent, range, and quality" of systematic reviews on pharmacist-led medication reviews. • In the methodology section, consider upgrading by providing detailed information on the databases searched, inclusion/exclusion criteria, and the criteria used to assess the quality of the systematic reviews. • In the conclusion section, it would be more impactful to highlight the main takeaways from the review and emphasize the need for further research in this area. Thank you for these comments. We have amended the abstract to address these comments. Line 26 There are different types of medication reviews undertaken in various settings. Line 31 “This scoping review aims to explore the extent and range of systematic reviews …” Lines 35,36 “Systematic reviews were included irrespective of participants, settings or outcomes and were excluded if pharmacists did not lead the delivery of the included interventions.” Lines 49-53 There is mixed evidence of effectiveness for medication reviews across settings and patient populations. There is limited data about the implementation of medication reviews, therefore is difficult to ascertain which components of the intervention lead to improved outcomes. As medication reviews are widely implemented in practice, further research should explore the nature of the interventions, linking the components of these to outcomes. Introduction: • The introduction is clear and effectively sets the stage for the importance of medication reviews. Thank you • Consider incorporating a more explicit and succinct statement of the research question or objective to enhance clarity. A more explicit research question has been added (lines 75-77) “Therefore, our research question is, what is the systematic review evidence about the nature and effectiveness of medication review interventions conducted by pharmacists, and what are the gaps in research knowledge?” Methodology: • Positive feedback is provided for the methodology, indicating satisfaction with the methods used. Thank you Overall Impression: • The paper is well-researched and provides a thorough examination of existing systematic reviews on pharmacist-led medication reviews. Thank you • While the language is generally clear, attention to detail in sentence construction and grammar is recommended. Thank you for bringing these errors to our attention. This has been reviewed and actioned. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0309729.r002
19 Aug 2024 Decision Letter - Nasser Hadal Alotaibi, Editor Pharmacist-led medication reviews: A scoping review of systematic reviews PONE-D-23-33977R1 Dear Dr. Craske, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript titled as Pharmacist-led medication reviews: A Scoping Review of systematic reviews submitted to PLOS ONE with manuscript number PONE-D-23-33977 for possible publication is now suitable for the publication as all the points previously raised has been well addressed. The manuscript is updated now and well modified as suggested. Now, its recommended for the Acceptance of this manuscript. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0309729.r003
Formally Accepted
27 Aug 2024 Acceptance Letter - Nasser Hadal Alotaibi, Editor PONE-D-23-33977R1 PLOS ONE Dear Dr. Craske, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Nasser Hadal Alotaibi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0309729.r004

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