title: Evidence of the clinical effectiveness of cognitive pharmaceutical services for aged patients.
abstract: BACKGROUND
  cognitive pharmaceutical services (CPSs) encompass a variety of pharmacists' interventions to optimise pharmacotherapy. The clinical effectiveness of CPSs for aged patients remains controversial.
  
  
  OBJECTIVE
  to analyse and describe the evidence of the clinical effectiveness of CPSs in aged patients by means of performing a systematic review of systematic reviews.
  
  
  METHODS
  using the recommended methodology by Cochrane, a search was undertaken for systematic reviews of the clinical effectiveness of CPSs in MEDLINE, EMBASE, DOAJ, SCIELO and COCHRANE LIBRARY. Reviews were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Quality of the evidence in the reviews was ranked using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
  
  
  RESULTS
  a total of 14 systematic reviews and one meta-analysis were analysed. The overall quality of the reviews was moderate. High and moderate strength of evidence was found for the positive effect of certain CPSs on reducing the number and improving the appropriateness of medicines. There was conflicting evidence of the effect on adherence. There was limited evidence of high and moderate strength on clinical outcomes. No positive evidence was found on mortality, hospitalisations, functional capacity and cognitive function. No systematic reviews reported the effect on the level of control of health problems.
  
  
  CONCLUSIONS
  certain types of CPSs reduce the number of medicines and improve the appropriateness of prescriptions. Longer follow-up periods and/or the use of surrogate clinical variables measuring the short-term impact are required to demonstrate the effect on clinical outcomes.
authors.affiliation: Faculty of Health Sciences, Pharmacy Department, San Jorge University, Campus Universitario Villanueva de Gállego Autovía A-23 Zaragoza-Huesca Km. 299, Villanueva de Gállego, Zaragoza, Spain. lsaezbenito@usj.es
authors.forename: Loreto
authors.initials: L
authors.lastname: Sáez-Benito
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Llimos
authors.forename: Eleonora
authors.initials: E
authors.lastname: Feletto
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gastelurrutia
authors.forename: Fernando
authors.initials: F
authors.lastname: Martinez-Martinez
authors.forename: Shalom I
authors.initials: SI
authors.lastname: Benrimoj
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D003071:Cognition; D057186:Comparative Effectiveness Research; D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006299:Health Services for the Aged; D006801:Humans; D057970:Inappropriate Prescribing; D055118:Medication Adherence / Q000523:psychology*; D054539:Medication Therapy Management; D016896:Treatment Outcome
keywords: aged patients; cognitive services; comparative effectiveness research; medication review; medication therapy management; pharmacists; systematic review