What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis

What types of information do pharmacists include in comprehensive medication management review reports? 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A qualitative content analysis Tarik Al-Diery, Hollie Freeman, Amy Theresa Page, Amanda J Cross, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2416278/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Mar, 2023 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted 5 You are reading this latest preprint version Abstract Introduction Comprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown. This study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews. Methods Australian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis. Results Seventy-two de-identified reports from eight consultant pharmacists were included for analysis. From the evaluated reports, four major categories of information were identified: 1) consumer details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%); 2) pharmacist assessment including assessment of the consumer (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%); 3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%); and 4) consumer-centred experiences such as perspective on medicines (n = 56, 78%). Reporting of consumer-centred experiences appeared most variably in the included reports, including consumer concerns (n = 38, 53%), willingness for change (n = 27, 38%), consumer preferences (n = 13, 18%), and consumer goals (n = 7, 10%). Conclusion Pharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the consumers they care for. However, despite the breadth of information included in a comprehensive medication management review report, our study suggests that there is wide variability across reports, which has the potential to impact consistent service delivery. medication review medication therapy management pharmacy practice qualitative research content analysis Figures Figure 1 Introduction The high prevalence of polypharmacy and medication-related problems in older consumers with multiple comorbidities places importance on optimising interventions to improve medicines use [ 1 – 4 ]. Comprehensive medication management reviews are a clinical service offered by pharmacists with the aim of identifying and resolving potential medication-related problems and optimising evidence-based therapeutic care [ 5 – 9 ]. Medication reviews have been found to reduce medication-related problems such as drug-drug interactions and optimisation of pharmacotherapy, but the extent of the effectiveness on clinical outcomes, hospital admission, and mortality remains unclear [ 3 , 10 – 18 ]. Nonetheless, globally, pharmacist-led medication reviews have been effective in promoting consumer-centred care through an interprofessional approach[ 19 ]. While medication review processes vary internationally on how information is collected and presented, the focus of medication reviews is generally intended to be consumer-centred in addressing key medical and social issues[ 6 – 8 ]. The Australian ‘Home Medicines Review’ (HMR) service is designed to target the management of high-risk consumers who may have multiple comorbidities, issues with medication non-adherence, or are not optimised in their care from an evidence-based medicine approach[ 20 , 21 ]. In Australia, HMRs are a government-funded collaborative service that is undertaken by a consultant pharmacist upon referral from a general practitioner (GP)[ 20 , 22 ]. Consultant pharmacists undertake a multifaceted process that often involves a prior evaluation of medical and social history, an interview in the home, followed by an written report with recommendations to the GP[ 20 ]. Despite medication reviews being extensively utilised in Australia and in other parts of the world for over 20 years, current literature on medication reviews mainly focuses on the impact a pharmacist has on direct or surrogate health outcomes with varying results[ 17 , 21 ]. Surrogate outcomes include identifying medication-related problems and the recommendations made as a result, and the perceptions of consumers and GPs toward the medication review process[ 17 , 21 , 23 – 33 ]. Other retrospective studies have evaluated the types of medication-related problems identified, the prevalence of their identification, and the subsequent acceptance and implementation of medicines review pharmacist recommendations by the GPs[ 10 , 15 , 17 , 28 ]. While previous studies have reported on the impact that pharmacists have on health outcomes through some of the content they include in their medication review reports, there is a gap in understanding the types of information included by pharmacists in medication review reports, beyond medication-related problems, and the frequency of reporting[ 17 , 21 ]. Therefore, the present study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews. Ethics approval This research was approved by the Human Ethics Office of the University of Western Australia, approval number 2021/ET000392. Methods Study design The present study sought to retrospectively analyse written HMR reports by consultant pharmacists for consumers living in the community. Participants were invited to de-identify and upload their 10 most recent HMR reports and provide answers to demographic questions via an anonymous online questionnaire. Each report was screened by one author (KL) to ensure correct de-identification procedures. A random selection of the reports, evenly stratified by each participant, were included for qualitative content analysis. Participants and settings Eligible participants were Australian consultant pharmacists credentialled with one of the accrediting organisations. At the point of data collection, the Australian Association of Consultant Pharmacists (AACP) and The Society of Hospital Pharmacists of Australia (SHPA) were the two organisations responsible for the accreditation of pharmacists to undertake medicine management reviews [ 34 , 35 ]. To gain accreditation, pharmacists must be currently registered pharmacists, show evidence of fulfilling specified continued professional development, and have completed a competency-based assessment relevant for medicine management reviews [ 34 , 35 ]. At the time of writing, there are over 2000 accredited pharmacists across all Australian States and Territories [ 36 ]. Recruitment Participants were recruited over a 10-week recruitment period from June to August 2021. To capture the practices of pharmacists across Australia, participants were recruited using an online advertisement, which was promoted through several means including social media and email correspondence. The advertisement was shared in private Facebook groups, comprising of Australian consultant pharmacists, as well as on the professional LinkedIn and Twitter profiles of the research team. It was also sent to accrediting bodies (AACP and SHPA), medicine review support services, and personal contacts of the research team via email. Participants were eligible for the study if they were consultant pharmacist practising in Australia. Data analysis and quality assurance The de-identified reports were imported into NVivo (version 12 Plus) and coded inductively [ 37 , 38 ]. To create an initial analytical framework, one report was selected at random, independently coded by two authors (HF and KL), and then compared. Discrepancies were resolved through team discussion and the analytical framework was updated accordingly. One author (HF) then coded all remaining reports independently using the initial analytical framework. Any emerging codes beyond the initial analytical framework were added to the framework by HF, following discussion with KL, an experienced qualitative researcher and consultant pharmacist. The finalised analytical framework was then independently applied to 10% of the total reports by KL. Discrepancies were compared and resolved through team discussion. Quality assurance of the analytical process was established in a number of ways [ 39 ]: Credibility was established through analyst triangulation between HF and KL, and peer debriefing with an audience of pharmacy academics and students. Dependability and confirmability were established through the development of an audit trail to record all coding decisions, as well as via analyst triangulation. Results Twenty-four pharmacists responded to the advertisement of interest for inclusion into the study, of which nine pharmacists uploaded de-identified reports and completed the demographic survey. The written documents uploaded by one pharmacist were excluded as they were for people residing in residential aged care facilities. Two pharmacists uploaded only nine reports, giving a total of 88 submitted de-identified reports. After stratified random selection, nine reports from eight pharmacists (a total of 72 included reports) were included for analysis. Most participants were experienced pharmacists with greater than ten years of work experience and working in the metropolitan area. A summary of the pharmacist demographics can be seen in Table 1 . Table 1 Participant demographics (n = 8). Participants demographics Options to select n (%) Age 61 years + 3 (38) 51–60 years 3 (38) 31–40 years 2 (25) Gender Female 5 (63) Male 3 (38) State Victoria 4 (50) Queensland 1 (13) Western Australia 1 (13) New South Wales 1 (13) Tasmania 1 (13) Geographical setting Metropolitan 6 (75) Rural 1 (13) Metropolitan + rural 1 (13) Highest level of education achieved Bachelor’s degree 4 (50) Graduate certificate 1 (13) Master’s degree 1 (13) Doctorate degree 2 (25) Accreditation achieved through Australian Association of Consultant Pharmacists only 6 (75) Society of Hospital Pharmacists of Australia only 0 (0) Australian Association of Consultant Pharmacists AND Society of Hospital Pharmacists of Australia 2 (25) Years as a registered pharmacist 0–9 1 (13) 10–19 1 (13) 20–29 0 (0) 30–39 2 (25) 40–49 1 (13) 50–59 2 (25) Years accredited as consultant pharmacist 0–9 4 (50) 10–19 2 (25) 20–29 2 (25) Average number of Home Medicine Reviews conducted a month 0–5 4 (50) 6–15 2 (25) 16–20 2 (25) We identified four major categories of information included in the HMR reports: consumer details, pharmacist assessment plan, pharmacist recommendations, and consumer-centred experiences. Figure 1 displays the four major categories and respective codes. Consumer details Participants recorded multiple details such as the medical, medicine, and social history, along with other factors such as consumer characteristics and review process details (see Table 2 ). The following types of information were commonly found across the reports: current medicine history (97%), medicine administration (82%), medical history (81%), clinical parameters (78%), any other healthcare practitioners involved (67%), and allergies and adverse drug reactions (ADRs) (57%) in at least one of their reports. The following types of information were less commonly found across the reports: documentation of diet and exercise (49%), smoking status (38%), and alcohol status (36%). Table 2 Consumer details from written reports (n = 72). Code and subcodes Number of written reports containing each type of information n(%) 1. Medical information 58 (81) Clinical parameters 56 (78) Laboratory and pathology data 44 (61) Tests and observations 34 (47) Medical history 58 (81) Medical conditions 47 (65) Vaccination history 22 (31) Family medical history 5 (7) Other involved health care practitioners 48 (67) Allergies and adverse drug reactions 41 (57) Biometric information 20 (28) Diet and exercise 35 (49) Smoking status 27 (38) Alcohol status 26 (36) Details of family and living situation 22 (31) Employment 6 (8) Hobbies 3 (4) 2. Consumer Characteristics 2 (3) 3. Community pharmacy details 48 (67) 4. Medicine history 70 (97) Changes to medicines 53 (74) Medicine administration 59 (82) Medicines taken currently 70 (97) Medicines taken in the past 34 (47) Medicines not started yet 5 (7) 5. Review process information 72 (100) Date of interview 72 (100) How review was conducted 62 (86) People present during the interview 16 (22) Reason for referral 30 (42) Information from previous medicine review 10 (14) Date of referral 15 (21) Pharmacist assessment plan Assessment of the consumer was the most reported information type (97%), followed by an assessment of the medicines (94%), then assessment of medicine related issues (83%). Table 3 demonstrates that participants assessed the consumer in many ways. Of note, the most included information in reports were the participants’ assessment of potential medicine issues (75%), medicine and device knowledge (74%), symptoms (74%), and compliance with taking medicines (74%). Medicine management and storage at home was less commonly included, with 40% of reports assessing this point. Table 3 Pharmacist assessment plan from written reports (n = 72). Code and subcodes Number of written reports containing each type of information n(%) Assessment of consumer 70 (97) Assessment of symptoms 53 (74) Medicine and device knowledge 53 (74) Information and treatment received from other health care practitioners 26 (36) Actions to improve condition 13 (18) Knowledge of health conditions 7 (10) Pharmacist concerns from the assessment 13 (18) Pharmacist concerns about consumer 13 (18) Pharmacist observations of consumer during the interview 12 (17) Assessment of medicine management 68 (94) Adherence with taking their medicines 53 (74) Comments on medicine management 47 (65) Medicine management and storage at home 29 (40) Assessment of medicine related issues 60 (83) Potential medicine issue 54 (75) Actual medicine issue or adverse effect 26 (36) Suspected medicine issue 18 (25) Pharmacist recommendations As shown in Table 4 , pharmacological recommendations were made in 93% of reports. Recommendations to commence or re-commence a medicine (74%) were more common than recommendations to cease a medicine (49%). Justification for recommendations varied, with 64% providing pharmacological and clinical rationale, but only 49% provided details of the resources and references used to support one or more of their recommendations. Table 4 pharmacist recommendations from written reports (n = 72). Code and subcodes Number of written reports containing each type of information n (%) Pharmacists request for referring doctor 38 (53) Doctor to update medical records 17 (24) Provide updated information to other health care practitioners 18 (25) Request for GP management plan 16 (22) Action request for community pharmacy 4 (6) Rationale for recommendation 58 (81) Pharmacological and clinical rationale 46 (64) Resources and references used 35 (49) Supporting information around criteria for subsidised prescribing 4 (6) Pharmacological recommendation 67 (93) Change dose of medicine 39 (54) Consider commencing or recommencing a medicine 53 (74) Cease medicine 35 (49) Modify current medicine management 18 (25) Administration aid recommended 6 (8) Consumer-centred experiences Table 5 summarises the frequency of including information pertaining to consumer-centred experiences. Of note, the consumer perspective was reported in 81% of reports, with the most common sub-type being consumers’ opinions about medications (78%). Reporting of other aspects of consumer-centred experience was less common, including consumer concerns (53%), willingness for change (38%), consumer preferences (18%), and consumer goals (10%). The least commonly included information sub-type was consumers’ perspectives of other healthcare professionals involved in their care (4%). Table 5 Consumer-centred experiences from written reports (n = 72). Code and subcodes Number of written reports containing each type of information n (%) Consumer perspectives 58 (81) Perspectives on medicines 56 (78) Perspectives on health conditions 19 (26) Perspectives on other treatments received 6 (8) Perspectives on healthcare professionals 3 (4) Consumer willingness for change 27 (38) Willingness to change medicine management 18 (25) Willingness to make lifestyle changes 14 (19) Consumer concerns 38 (53) Medicine concerns or difficulties 21 (29) Health concerns or complaints 25 (35) Consumer preferences 13 (18) Consumer goals 7 (10) Consumer queries 6 (8) Discussion The present study adds to extant literature on comprehensive medication management reviews by going beyond characterisation of medication-related problems through exploration of the variety of information types included in medication review reports. We identified that pharmacists reported a wide variety of information, broadly classified into consumer details, pharmacist assessment plan, pharmacist recommendations, and consumer-centred experiences. While a recent study [ 22 ] evaluated the alignment of HMR reports with best practice guidelines, the inductive approach taken in our study provides further insight into other types of information included in HMR reports, such as a details of family and living situations, medicine management and storage at home, provision of practical prescribing information, and consumers' willingness for behaviour change. Our study has revealed that pharmacists include much more information than medication-related information in the HMR reports, and suggests a holistic assessment of consumers including social, physical, and behaviour considerations, as evident through the reporting of diet and exercise, and consumer concerns, preferences, and goals. Despite the holistic nature of the reports included in our analysis, the frequency of each information type that was included in the reports varied widely. Given the inconclusive evidence surrounding the clinical benefits of comprehensive medication management reviews (such as in terms of hospital admissions) [ 3 , 10 – 18 ], the variability of reporting identified by our study sheds light into why the evidence of clinical benefit may be inconclusive. This variability was also recently noted by Patounas and colleagues [ 22 ]. Furthermore, a lack of a standardised approach in written reporting suggests that there could be inconsistencies in the level of care consumers are receiving, as well as the quality of written reports GPs receive. It is possible that one component of the perception and uptake of the medicine management review program overall is its consistency and replicability [ 40 , 41 ]. Standardised question templates for medicine reviews that allow for flexibility in reporting depending on the pharmacist work environment may contribute to a higher consistency in issues found, leading to interventions also having a higher degree of replicability [ 42 ]. Nonetheless, obstacles for maintaining consistency in medicines review reports include lack of auditing of medicines review reports and the time-intensive nature of writing medicines review reports which require ongoing pharmacist education and training that may not be readily available in healthcare systems [ 22 ]. Participants in our study were consistent in recording consumer details and pharmacist assessments such as medical information, medicine history, and assessment of the consumer, though inconsistent in reporting the reasons for the medicines review referral and medicine management and storage at home, which is similar to the findings from an earlier study [ 22 ]. Other work has shown that the reasons for the medicines review referral is inconsistent on both the original referral from the GP and the written report [ 22 ]. Previous research in the hospital setting of the pharmacist-doctor relationship in clinical reporting suggests that pharmacists traditionally prefer to communicate information verbally rather than through written documentation due to ease in communication and that doctors are not always inclined to read their reports, particularly when they are lengthy [ 43 ], and that the service may be perceived as external rather than integrated [ 41 ]. Limited GP acknowledgment of written reports has been identified in other settings as a barrier to high quality reports [ 44 ]. However, it is improbable that these written reports are supplemented by verbal communication. The reasons for why participants were not consistent in reporting certain information were beyond the scope of this study. As consultant pharmacists have been encouraged to tailor their written reports to the preferences of individual referring GPs, the variation observed may reflect that the experienced consultant pharmacists participating in this study are writing tailored reports. Medicine management review processes in other parts of the world emphasise a consumer-centred approach to capture not only existing medicines and medicine related problems, but also the consumer experience (social and behavioural concerns), to ensure that full consumer medical experience is captured and appropriately addressed [ 6 , 7 ]. Previous research regarding consumer experiences with medication reviews has largely focused on consumer perceptions regarding the benefits and barriers of the medicine review service [ 33 , 45 ]. Our study demonstrated that a small proportion of reports acknowledge consumer concerns, preferences, and goals. However, findings from the DREAMeR-study suggest that clinical medication reviews that focus on patient goals results in a better quality of life and decreases the number of health problems [ 46 ]. The process evaluation the AusTaper study of pharmacist medicines reviews in general practice demonstrated that synergy in facilitating patient understanding and shared decision making was a key component of successful pharmacist reviews [ 47 ]. The findings from our study therefore highlights that more work is required to acknowledge patient goals, in order to ensure the full consumer-centred experience is being captured. Future research is needed to understand what factors within the medicines review reports are likely to affect a GPs decision to make an implementation from a pharmacist recommendation, and whether citing references leads to better implementation rates. Ideally, future research would investigate a simulated consumer referred by an unknown GP for whom participating consultant pharmacists write a report. The variation in content of the written report could then be assessed independently. There is minimal literature to inform on the type of information to be included in medicines review reports [ 17 , 20 , 28 ]. A multidisciplinary consensus study between pharmacists and GPs can potentially create a more flexible standardised reporting method that improves consistency in reported information and improve GP implementation rates of pharmacist recommendations. This study had several strengths and limitations. Strengths included a sample of participants from across five States and Territories of Australia. Nonetheless, limitations of our research include the small sample size of pharmacists recruited and the number of included written reports. Within the context of a qualitative content analysis, our study reports on valuable patterns of written reports that still captures pharmacist behaviours in the medicine management review process, regardless of the sample size, which can then be applied to a larger sample size in the future. A further limitation of this study is that the reports received were predominantly from pharmacists with many years of experience, both in practice and as consultant pharmacist. Without data from younger, less experienced pharmacists, it is hard to make conclusions reflective of all consultant pharmacists. A study incorporating a larger sample would therefore be recommended to confirm the results found in this study and reduce the biases that have been identified in the current study. Conclusion This study demonstrated that pharmacists include a wide variety of information within their comprehensive medication management review reports, beyond reporting on medication-related problems. Our study suggests that pharmacists perform holistic assessments of patients, taking into consideration social, physical, and behavioural factors; and are practical in their recommendations to support prescribing. Despite the holistic assessment of consumers, more work is needed to include consumer goals and preferences within the reports. Furthermore, despite the breadth of information included in a comprehensive medication management review report, our study suggests that there is wide variability across reports, which has the potential to impact consistent service delivery. Declarations The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Author contribution: All authors contributed to the study conception and design. Data were collected by Hollie Freeman, who developed the analytical framework in conjunction with senior author Kenneth Lee. Data analysis was completed by Tarik Al-Diery in conjunction with Kenneth Lee and Amy Page. The first draft of the manuscript was completed by Hollie Freeman and Tarik Al-Diery. All authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript. Data availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Human Ethics Office of the University of Western Australia, approval number 2021/ET000392. Consent to participate Informed consent was obtained from all individual participants included in the study. References Page AT, Potter K, Clifford R, et al. Deprescribing in older people. 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Doctor–pharmacist communication in hospitals: strategies, perceptions, limitations and opportunities. Int J Clin Pharm. 2018;40(2):464–73. https://doi.org/10.1007/s11096-018-0592-1 . Pullinger W, Franklin BD. Pharmacists' documentation in patients' hospital health records: issues and educational implications. Int J Clin Pharm. 2010;18(2):108–15. White L, Klinner C, Carter S. Consumer perspectives of the Australian Home Medicines Review Program: benefits and barriers. Res Social Adm Pharm. 2012;8(1):4–16. https://doi.org/10.1016/j.sapharm.2010.11.003 . Verdoorn S, Kwint H-F, Blom JW, et al. Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: a randomised controlled trial (DREAMeR-study). PLoS med. 2019;16(5):e1002798. https://doi.org/10.1371/journal.pmed.1002798 . Parkinson L, Magin P, Etherton-Beer C, et al. Engaging general practice and patients with AusTAPER, a pharmacist facilitated web‐based deprescribing tool. J Pharm Pract Res. 2021;51(2):154–9. Cite Share Download PDF Status: Published Journal Publication published 17 Mar, 2023 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted Editorial decision: Minor revisions 13 Feb, 2023 Reviewers agreed at journal 08 Jan, 2023 Reviewers invited by journal 03 Jan, 2023 Editor assigned by journal 02 Jan, 2023 First submitted to journal 26 Dec, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2416278","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":164574687,"identity":"6a74a174-c5c6-4ff1-a45c-9e403abb48d5","order_by":0,"name":"Tarik Al-Diery","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYJCCgw0MDDIMh0HMCrCAAV7lPFAtPBAtZ4jUwgjWcgDEaiNCiz372YcHZzDY8fAdZz72mXeedWIDe/M2CYYyO9y28KQbHNzAkMwjeZgteTbvtvTEBp5jZRIM55LxOCyN4eADBmYeg8M8xsy82w4nNkjkmEkwtjHj1sL/DKSlHqiF/zMz7xygFvk3IC31uLVIAG3ZwHAYZAszM28DyBYekJbDuLXcANoyw+A4yC/GjHOOpRu38aQVWyScO45TC3t/GvPHnopqOb7zhx8zvKmxlu1nP7zxxoeyapxaIAAaEUw8DMwMbCBWAhsBHTDA+IMBFlDEahkFo2AUjIKRAAB9Xkywvt7D4QAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-0295-7386","institution":"Qatar University College of Pharmacy","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Tarik","middleName":"","lastName":"Al-Diery","suffix":""},{"id":164574688,"identity":"e36ac811-13d8-42ec-8b9e-9af57afa75ce","order_by":1,"name":"Hollie Freeman","email":"","orcid":"","institution":"The University of Western Australia School of Allied Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hollie","middleName":"","lastName":"Freeman","suffix":""},{"id":164574689,"identity":"d4120651-be89-4e92-a118-4933fc98b981","order_by":2,"name":"Amy Theresa Page","email":"","orcid":"","institution":"University of Western Australia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amy","middleName":"Theresa","lastName":"Page","suffix":""},{"id":164574690,"identity":"6440b3ae-448d-4682-b2c1-daff974b7a84","order_by":3,"name":"Amanda J Cross","email":"","orcid":"","institution":"Monash University Faculty of Pharmacy and Pharmaceutical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"J","lastName":"Cross","suffix":""},{"id":164574691,"identity":"9fcb90aa-aa4c-4793-8cb6-5f3d8bc28d73","order_by":4,"name":"Deborah Hawthorne","email":"","orcid":"","institution":"University of Western Australia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Deborah","middleName":"","lastName":"Hawthorne","suffix":""},{"id":164574692,"identity":"78c8e069-0501-46dc-a1e8-c7e31bee59ff","order_by":5,"name":"Kenneth Lee","email":"","orcid":"","institution":"University of Western Australia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kenneth","middleName":"","lastName":"Lee","suffix":""}],"badges":[],"createdAt":"2022-12-26 15:17:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2416278/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2416278/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11096-023-01561-5","type":"published","date":"2023-03-17T20:02:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":31309729,"identity":"690876c3-b5ac-44d4-b1b8-4693764402f5","added_by":"auto","created_at":"2023-01-09 15:20:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35755,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMajor categories and corresponding codes of the written report content analysis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2416278/v1/42aad65ad866b7348576b5f1.png"},{"id":44722887,"identity":"a16929bf-e6f1-4934-85a5-f39f9090243d","added_by":"auto","created_at":"2023-10-16 20:09:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":731398,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2416278/v1/da322f27-27e8-40cf-a1fd-f5d43af528fd.pdf"}],"financialInterests":"","formattedTitle":"What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe high prevalence of polypharmacy and medication-related problems in older consumers with multiple comorbidities places importance on optimising interventions to improve medicines use [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Comprehensive medication management reviews are a clinical service offered by pharmacists with the aim of identifying and resolving potential medication-related problems and optimising evidence-based therapeutic care [\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Medication reviews have been found to reduce medication-related problems such as drug-drug interactions and optimisation of pharmacotherapy, but the extent of the effectiveness on clinical outcomes, hospital admission, and mortality remains unclear [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Nonetheless, globally, pharmacist-led medication reviews have been effective in promoting consumer-centred care through an interprofessional approach[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile medication review processes vary internationally on how information is collected and presented, the focus of medication reviews is generally intended to be consumer-centred in addressing key medical and social issues[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The Australian \u0026lsquo;Home Medicines Review\u0026rsquo; (HMR) service is designed to target the management of high-risk consumers who may have multiple comorbidities, issues with medication non-adherence, or are not optimised in their care from an evidence-based medicine approach[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In Australia, HMRs are a government-funded collaborative service that is undertaken by a consultant pharmacist upon referral from a general practitioner (GP)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Consultant pharmacists undertake a multifaceted process that often involves a prior evaluation of medical and social history, an interview in the home, followed by an written report with recommendations to the GP[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite medication reviews being extensively utilised in Australia and in other parts of the world for over 20 years, current literature on medication reviews mainly focuses on the impact a pharmacist has on direct or surrogate health outcomes with varying results[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Surrogate outcomes include identifying medication-related problems and the recommendations made as a result, and the perceptions of consumers and GPs toward the medication review process[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Other retrospective studies have evaluated the types of medication-related problems identified, the prevalence of their identification, and the subsequent acceptance and implementation of medicines review pharmacist recommendations by the GPs[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile previous studies have reported on the impact that pharmacists have on health outcomes through some of the content they include in their medication review reports, there is a gap in understanding the types of information included by pharmacists in medication review reports, beyond medication-related problems, and the frequency of reporting[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, the present study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003e This research was approved by the Human Ethics Office of the University of Western Australia, approval number 2021/ET000392.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe present study sought to retrospectively analyse written HMR reports by consultant pharmacists for consumers living in the community. Participants were invited to de-identify and upload their 10 most recent HMR reports and provide answers to demographic questions via an anonymous online questionnaire. Each report was screened by one author (KL) to ensure correct de-identification procedures. A random selection of the reports, evenly stratified by each participant, were included for qualitative content analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and settings\u003c/h2\u003e \u003cp\u003eEligible participants were Australian consultant pharmacists credentialled with one of the accrediting organisations. At the point of data collection, the Australian Association of Consultant Pharmacists (AACP) and The Society of Hospital Pharmacists of Australia (SHPA) were the two organisations responsible for the accreditation of pharmacists to undertake medicine management reviews [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. To gain accreditation, pharmacists must be currently registered pharmacists, show evidence of fulfilling specified continued professional development, and have completed a competency-based assessment relevant for medicine management reviews [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. At the time of writing, there are over 2000 accredited pharmacists across all Australian States and Territories [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eRecruitment\u003c/h2\u003e \u003cp\u003eParticipants were recruited over a 10-week recruitment period from June to August 2021. To capture the practices of pharmacists across Australia, participants were recruited using an online advertisement, which was promoted through several means including social media and email correspondence. The advertisement was shared in private Facebook groups, comprising of Australian consultant pharmacists, as well as on the professional LinkedIn and Twitter profiles of the research team. It was also sent to accrediting bodies (AACP and SHPA), medicine review support services, and personal contacts of the research team via email. Participants were eligible for the study if they were consultant pharmacist practising in Australia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis and quality assurance\u003c/h2\u003e \u003cp\u003eThe de-identified reports were imported into NVivo (version 12 Plus) and coded inductively [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. To create an initial analytical framework, one report was selected at random, independently coded by two authors (HF and KL), and then compared. Discrepancies were resolved through team discussion and the analytical framework was updated accordingly. One author (HF) then coded all remaining reports independently using the initial analytical framework. Any emerging codes beyond the initial analytical framework were added to the framework by HF, following discussion with KL, an experienced qualitative researcher and consultant pharmacist. The finalised analytical framework was then independently applied to 10% of the total reports by KL. Discrepancies were compared and resolved through team discussion.\u003c/p\u003e \u003cp\u003eQuality assurance of the analytical process was established in a number of ways [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCredibility was established through analyst triangulation between HF and KL, and peer debriefing with an audience of pharmacy academics and students.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDependability and confirmability were established through the development of an audit trail to record all coding decisions, as well as via analyst triangulation.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTwenty-four pharmacists responded to the advertisement of interest for inclusion into the study, of which nine pharmacists uploaded de-identified reports and completed the demographic survey. The written documents uploaded by one pharmacist were excluded as they were for people residing in residential aged care facilities. Two pharmacists uploaded only nine reports, giving a total of 88 submitted de-identified reports. After stratified random selection, nine reports from eight pharmacists (a total of 72 included reports) were included for analysis. Most participants were experienced pharmacists with greater than ten years of work experience and working in the metropolitan area. A summary of the pharmacist demographics can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant demographics (n\u0026thinsp;=\u0026thinsp;8).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants demographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOptions to select\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 years +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;60 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eState\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVictoria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQueensland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWestern Australia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNew South Wales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTasmania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eGeographical setting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetropolitan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetropolitan\u0026thinsp;+\u0026thinsp;rural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education achieved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctorate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAccreditation achieved through\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralian Association of Consultant Pharmacists only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSociety of Hospital Pharmacists of Australia only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralian Association of Consultant Pharmacists AND Society of Hospital Pharmacists of Australia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eYears as a registered pharmacist\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eYears accredited as consultant pharmacist\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAverage number of Home Medicine Reviews conducted a month\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe identified four major categories of information included in the HMR reports: consumer details, pharmacist assessment plan, pharmacist recommendations, and consumer-centred experiences. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the four major categories and respective codes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eConsumer details\u003c/h2\u003e \u003cp\u003eParticipants recorded multiple details such as the medical, medicine, and social history, along with other factors such as consumer characteristics and review process details (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The following types of information were commonly found across the reports: current medicine history (97%), medicine administration (82%), medical history (81%), clinical parameters (78%), any other healthcare practitioners involved (67%), and allergies and adverse drug reactions (ADRs) (57%) in at least one of their reports. The following types of information were less commonly found across the reports: documentation of diet and exercise (49%), smoking status (38%), and alcohol status (36%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConsumer details from written reports (n\u0026thinsp;=\u0026thinsp;72).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode and subcodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of written reports containing each type of information n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Medical information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (81)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (78)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory and pathology data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTests and observations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e58 (81)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccination history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily medical history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther involved health care practitioners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e48 (67)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAllergies and adverse drug reactions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e41 (57)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBiometric information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20 (28)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiet and exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetails of family and living situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHobbies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. \u003cb\u003eConsumer Characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2 (3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. \u003cb\u003eCommunity pharmacy details\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e48 (67)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. \u003cb\u003eMedicine history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e70 (97)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChanges to medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicine administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicines taken currently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicines taken in the past\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicines not started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. \u003cb\u003eReview process information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e72 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDate of interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow review was conducted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeople present during the interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason for referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation from previous medicine review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDate of referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePharmacist assessment plan\u003c/h2\u003e \u003cp\u003eAssessment of the consumer was the most reported information type (97%), followed by an assessment of the medicines (94%), then assessment of medicine related issues (83%). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrates that participants assessed the consumer in many ways. Of note, the most included information in reports were the participants\u0026rsquo; assessment of potential medicine issues (75%), medicine and device knowledge (74%), symptoms (74%), and compliance with taking medicines (74%). Medicine management and storage at home was less commonly included, with 40% of reports assessing this point.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePharmacist assessment plan from written reports (n\u0026thinsp;=\u0026thinsp;72).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode and subcodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of written reports containing each type of information n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment of consumer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (97)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment of symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicine and device knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation and treatment received from other health care practitioners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActions to improve condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of health conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePharmacist concerns from the assessment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e13 (18)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacist concerns about consumer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacist observations of consumer during the interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssessment of medicine management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e68 (94)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence with taking their medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComments on medicine management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicine management and storage at home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssessment of medicine related issues\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e60 (83)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotential medicine issue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActual medicine issue or adverse effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuspected medicine issue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePharmacist recommendations\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, pharmacological recommendations were made in 93% of reports. Recommendations to commence or re-commence a medicine (74%) were more common than recommendations to cease a medicine (49%). Justification for recommendations varied, with 64% providing pharmacological and clinical rationale, but only 49% provided details of the resources and references used to support one or more of their recommendations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epharmacist recommendations from written reports (n\u0026thinsp;=\u0026thinsp;72).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCode and subcodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNumber of written reports containing each type of information n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePharmacists request for referring doctor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38 (53)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDoctor to update medical records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eProvide updated information to other health care practitioners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eRequest for GP management plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAction request for community pharmacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4 (6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRationale for recommendation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e58 (81)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePharmacological and clinical rationale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResources and references used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e35 (49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupporting information around criteria for subsidised prescribing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePharmacological recommendation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e67 (93)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange dose of medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e39 (54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsider commencing or recommencing a medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e53 (74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCease medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e35 (49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModify current medicine management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e18 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministration aid recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eConsumer-centred experiences\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarises the frequency of including information pertaining to consumer-centred experiences. Of note, the consumer perspective was reported in 81% of reports, with the most common sub-type being consumers\u0026rsquo; opinions about medications (78%). Reporting of other aspects of consumer-centred experience was less common, including consumer concerns (53%), willingness for change (38%), consumer preferences (18%), and consumer goals (10%). The least commonly included information sub-type was consumers\u0026rsquo; perspectives of other healthcare professionals involved in their care (4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConsumer-centred experiences from written reports (n\u0026thinsp;=\u0026thinsp;72).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode and subcodes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of\u003c/p\u003e \u003cp\u003ewritten reports containing each type of information n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eConsumer perspectives\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (81)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePerspectives on medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePerspectives on health conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePerspectives on other treatments received\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePerspectives on healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsumer willingness for change\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e27 (38)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWillingness to change medicine management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWillingness to make lifestyle changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsumer concerns\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e38 (53)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedicine concerns or difficulties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHealth concerns or complaints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsumer preferences\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e13 (18)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsumer goals\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e7 (10)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsumer queries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6 (8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study adds to extant literature on comprehensive medication management reviews by going beyond characterisation of medication-related problems through exploration of the variety of information types included in medication review reports. We identified that pharmacists reported a wide variety of information, broadly classified into consumer details, pharmacist assessment plan, pharmacist recommendations, and consumer-centred experiences.\u003c/p\u003e \u003cp\u003eWhile a recent study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] evaluated the alignment of HMR reports with best practice guidelines, the inductive approach taken in our study provides further insight into other types of information included in HMR reports, such as a details of family and living situations, medicine management and storage at home, provision of practical prescribing information, and consumers' willingness for behaviour change. Our study has revealed that pharmacists include much more information than medication-related information in the HMR reports, and suggests a holistic assessment of consumers including social, physical, and behaviour considerations, as evident through the reporting of diet and exercise, and consumer concerns, preferences, and goals.\u003c/p\u003e \u003cp\u003eDespite the holistic nature of the reports included in our analysis, the frequency of each information type that was included in the reports varied widely. Given the inconclusive evidence surrounding the clinical benefits of comprehensive medication management reviews (such as in terms of hospital admissions) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the variability of reporting identified by our study sheds light into why the evidence of clinical benefit may be inconclusive. This variability was also recently noted by Patounas and colleagues [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, a lack of a standardised approach in written reporting suggests that there could be inconsistencies in the level of care consumers are receiving, as well as the quality of written reports GPs receive. It is possible that one component of the perception and uptake of the medicine management review program overall is its consistency and replicability [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Standardised question templates for medicine reviews that allow for flexibility in reporting depending on the pharmacist work environment may contribute to a higher consistency in issues found, leading to interventions also having a higher degree of replicability [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Nonetheless, obstacles for maintaining consistency in medicines review reports include lack of auditing of medicines review reports and the time-intensive nature of writing medicines review reports which require ongoing pharmacist education and training that may not be readily available in healthcare systems [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipants in our study were consistent in recording consumer details and pharmacist assessments such as medical information, medicine history, and assessment of the consumer, though inconsistent in reporting the reasons for the medicines review referral and medicine management and storage at home, which is similar to the findings from an earlier study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Other work has shown that the reasons for the medicines review referral is inconsistent on both the original referral from the GP and the written report [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Previous research in the hospital setting of the pharmacist-doctor relationship in clinical reporting suggests that pharmacists traditionally prefer to communicate information verbally rather than through written documentation due to ease in communication and that doctors are not always inclined to read their reports, particularly when they are lengthy [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], and that the service may be perceived as external rather than integrated [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Limited GP acknowledgment of written reports has been identified in other settings as a barrier to high quality reports [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, it is improbable that these written reports are supplemented by verbal communication. The reasons for why participants were not consistent in reporting certain information were beyond the scope of this study. As consultant pharmacists have been encouraged to tailor their written reports to the preferences of individual referring GPs, the variation observed may reflect that the experienced consultant pharmacists participating in this study are writing tailored reports.\u003c/p\u003e \u003cp\u003eMedicine management review processes in other parts of the world emphasise a consumer-centred approach to capture not only existing medicines and medicine related problems, but also the consumer experience (social and behavioural concerns), to ensure that full consumer medical experience is captured and appropriately addressed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Previous research regarding consumer experiences with medication reviews has largely focused on consumer perceptions regarding the benefits and barriers of the medicine review service [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Our study demonstrated that a small proportion of reports acknowledge consumer concerns, preferences, and goals. However, findings from the DREAMeR-study suggest that clinical medication reviews that focus on patient goals results in a better quality of life and decreases the number of health problems [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The process evaluation the AusTaper study of pharmacist medicines reviews in general practice demonstrated that synergy in facilitating patient understanding and shared decision making was a key component of successful pharmacist reviews [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The findings from our study therefore highlights that more work is required to acknowledge patient goals, in order to ensure the full consumer-centred experience is being captured.\u003c/p\u003e \u003cp\u003eFuture research is needed to understand what factors within the medicines review reports are likely to affect a GPs decision to make an implementation from a pharmacist recommendation, and whether citing references leads to better implementation rates. Ideally, future research would investigate a simulated consumer referred by an unknown GP for whom participating consultant pharmacists write a report. The variation in content of the written report could then be assessed independently. There is minimal literature to inform on the type of information to be included in medicines review reports [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A multidisciplinary consensus study between pharmacists and GPs can potentially create a more flexible standardised reporting method that improves consistency in reported information and improve GP implementation rates of pharmacist recommendations.\u003c/p\u003e \u003cp\u003eThis study had several strengths and limitations. Strengths included a sample of participants from across five States and Territories of Australia. Nonetheless, limitations of our research include the small sample size of pharmacists recruited and the number of included written reports. Within the context of a qualitative content analysis, our study reports on valuable patterns of written reports that still captures pharmacist behaviours in the medicine management review process, regardless of the sample size, which can then be applied to a larger sample size in the future. A further limitation of this study is that the reports received were predominantly from pharmacists with many years of experience, both in practice and as consultant pharmacist. Without data from younger, less experienced pharmacists, it is hard to make conclusions reflective of all consultant pharmacists. A study incorporating a larger sample would therefore be recommended to confirm the results found in this study and reduce the biases that have been identified in the current study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that pharmacists include a wide variety of information within their comprehensive medication management review reports, beyond reporting on medication-related problems. Our study suggests that pharmacists perform holistic assessments of patients, taking into consideration social, physical, and behavioural factors; and are practical in their recommendations to support prescribing. Despite the holistic assessment of consumers, more work is needed to include consumer goals and preferences within the reports. Furthermore, despite the breadth of information included in a comprehensive medication management review report, our study suggests that there is wide variability across reports, which has the potential to impact consistent service delivery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll authors contributed to the study conception and design. Data were collected by Hollie Freeman, who developed the analytical framework in conjunction with senior author Kenneth Lee. Data analysis was completed by Tarik Al-Diery in conjunction with Kenneth Lee and Amy Page. The first draft of the manuscript was completed by Hollie Freeman and Tarik Al-Diery. All authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Human Ethics Office of the University of Western Australia, approval number 2021/ET000392.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePage AT, Potter K, Clifford R, et al. Deprescribing in older people. Maturitas. 2016;91:115\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee GB, Etherton-Beer C, Hosking SM, et al. The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. 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J Pharm Pract Res. 2021;51(2):154\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"medication review, medication therapy management, pharmacy practice, qualitative research, content analysis","lastPublishedDoi":"10.21203/rs.3.rs-2416278/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2416278/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\n\u003cp\u003eComprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown. This study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews.\u003c/p\u003e\n\u003ch2\u003eMethods\u003c/h2\u003e\n\u003cp\u003eAustralian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis.\u003c/p\u003e\n\u003ch2\u003eResults\u003c/h2\u003e\n\u003cp\u003eSeventy-two de-identified reports from eight consultant pharmacists were included for analysis. From the evaluated reports, four major categories of information were identified: 1) consumer details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%); 2) pharmacist assessment including assessment of the consumer (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%); 3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%); and 4) consumer-centred experiences such as perspective on medicines (n = 56, 78%). Reporting of consumer-centred experiences appeared most variably in the included reports, including consumer concerns (n = 38, 53%), willingness for change (n = 27, 38%), consumer preferences (n = 13, 18%), and consumer goals (n = 7, 10%).\u003c/p\u003e\n\u003ch2\u003eConclusion\u003c/h2\u003e\n\u003cp\u003ePharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the consumers they care for. However, despite the breadth of information included in a comprehensive medication management review report, our study suggests that there is wide variability across reports, which has the potential to impact consistent service delivery.\u003c/p\u003e","manuscriptTitle":"What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-09 15:20:14","doi":"10.21203/rs.3.rs-2416278/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revisions","date":"2023-02-13T12:48:41+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2023-01-08T14:12:46+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-01-03T10:50:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-01-02T11:27:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Pharmacy","date":"2022-12-26T10:17:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"18c75977-0dda-440c-a325-c09217cc7f21","owner":[],"postedDate":"January 9th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:05:49+00:00","versionOfRecord":{"articleIdentity":"rs-2416278","link":"https://doi.org/10.1007/s11096-023-01561-5","journal":{"identity":"international-journal-of-clinical-pharmacy","isVorOnly":false,"title":"International Journal of Clinical Pharmacy"},"publishedOn":"2023-03-17 20:02:43","publishedOnDateReadable":"March 17th, 2023"},"versionCreatedAt":"2023-01-09 15:20:14","video":"","vorDoi":"10.1007/s11096-023-01561-5","vorDoiUrl":"https://doi.org/10.1007/s11096-023-01561-5","workflowStages":[]},"version":"v1","identity":"rs-2416278","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2416278","identity":"rs-2416278","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}