Cyclical medication management interventions in health care settings: a systematic review

Introduction: It is estimated that one in 30 patients experiences at least one preventable medication-related harm while receiving care. Cyclical medicine improvement interventions, where health systems continuously collect data, implement prescribing/dispensing interventions, review outcomes, and revise the intervention, have demonstrated health outcome improvements in a range of health care settings. This systematic review aimed to synthesize information on the characteristics and outcomes of cyclical medication management interventions.

Methods: Five databases were systematically searched for cyclical medication management interventions from 2000 to 2023. Studies were screened in a two-step process: title/abstract and full-text screening. All intervention, population, and outcome data were extracted. Intervention data were thematically categorized, and outcome data were categorized using Proctor's framework. The quality of data was assessed using the Mixed Methods Appraisal Tool (MMAT).

Results: Forty-five cyclical interventions from 46 publications were included. Most interventions studied cyclical medication management interventions in hospital settings (80%, n = 37) and utilized the plan-do-study-act framework to guide intervention design (64%, n = 29). Cyclical medication management interventions comprised multiple components (mean 2.4 components), with common components including practice standardization (n = 23), clinician feedback (n = 20), and clinician education (n = 18). One hundred and twenty-two outcome measures were extracted and categorized as implementation (n = 77), service (n = 41), and patient outcomes (n = 4). The quality of many publications was poor; 8 publications could not be scored or scored 0 on the MMAT, and the remaining publications scored on average (mean) 60% on the MMAT.

Conclusion: Cyclical medication management interventions show weak evidence that they can be implemented successfully and improve health system and service outcomes. Significant further research and health system structuring are required to address the quality issues surrounding cyclical medication management implementation and reporting.