European journal of hospital pharmacy : science and practice · 2026
Evaluation of a pharmacist-led medication review and optimisation service in the management of cardiometabolic disease.
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Coleman Pauline, Keenan Barry, Monaghan Monica, Glass Rachel, Gardner Sara, Fleming Glenda F, Scott Michael G
Аннотация
OBJECTIVES: Cardiometabolic disease, including heart failure, type 2 diabetes mellitus and chronic kidney disease, requires consistent implementation of guideline-directed therapies. Pharmacist-led medication reviews may support optimisation of evidence-based treatments, particularly sodium-glucose co-transporter 2 inhibitors (SGLT2i). This study assessed the feasibility of a pharmacist-led cardiometabolic medication review and optimisation service for adults with heart failure and/or type 2 diabetes mellitus, with or without concomitant chronic kidney disease. The primary objective was the guideline-recommended initiation of SGLT2i therapy in eligible patients. Secondary objectives were to assess patient engagement, explore medication appropriateness in an illustrative subset and capture patient perceptions of the service.
METHODS: This single-centre service evaluation was delivered remotely by a cardiometabolic pharmacist using a structured 7-step medication review process. Patients referred from hospital and primary care services were screened against predefined criteria. Process measures included referral uptake, review completion and initiation of SGLT2i therapy. In an exploratory subset, prescribing appropriateness was examined using the Person-Centred Medicines Appropriateness Index (PCMAI) and pharmacist interventions were classified using the Eadon scale. Estimated potential cost implications were modelled using the Sheffield Centre for Health and Related Research economic framework. Patient acceptability was assessed through an anonymous postal questionnaire.
RESULTS: Of 274 referrals, 98 patients were eligible and 75 (77%) completed a pharmacist-led review. Overall, 32/75 patients (43%) were started on SGLT2i therapy according to guideline criteria. In the exploratory subset, PCMAI scores decreased in five patients and 41 pharmacist interventions were Eadon-graded, corresponding to a modelled potential cost avoidance range of £8062-£17 384. Patient feedback (58% response rate) indicated high acceptability, with respondents highlighting clear communication, opportunity to ask questions and involvement in decision making.
CONCLUSION: The pharmacist-led service was feasible to deliver, acceptable to patients and supported the operationalisation of guideline-directed SGLT2i prescribing. Further longitudinal studies are needed to determine clinical and economic outcomes.
METHODS: This single-centre service evaluation was delivered remotely by a cardiometabolic pharmacist using a structured 7-step medication review process. Patients referred from hospital and primary care services were screened against predefined criteria. Process measures included referral uptake, review completion and initiation of SGLT2i therapy. In an exploratory subset, prescribing appropriateness was examined using the Person-Centred Medicines Appropriateness Index (PCMAI) and pharmacist interventions were classified using the Eadon scale. Estimated potential cost implications were modelled using the Sheffield Centre for Health and Related Research economic framework. Patient acceptability was assessed through an anonymous postal questionnaire.
RESULTS: Of 274 referrals, 98 patients were eligible and 75 (77%) completed a pharmacist-led review. Overall, 32/75 patients (43%) were started on SGLT2i therapy according to guideline criteria. In the exploratory subset, PCMAI scores decreased in five patients and 41 pharmacist interventions were Eadon-graded, corresponding to a modelled potential cost avoidance range of £8062-£17 384. Patient feedback (58% response rate) indicated high acceptability, with respondents highlighting clear communication, opportunity to ask questions and involvement in decision making.
CONCLUSION: The pharmacist-led service was feasible to deliver, acceptable to patients and supported the operationalisation of guideline-directed SGLT2i prescribing. Further longitudinal studies are needed to determine clinical and economic outcomes.