Hospital pharmacists play a key role in identifying and resolving instances of potentially inappropriate prescribing, particularly in multimorbid older patients with polypharmacy. This has been backed up by evidence from many randomised controlled trials showing that pharmacists reduce the incidence of adverse drug reactions, emergency department visits, and medication-related readmissions. Importantly, pharmacist interventions with a high proportion of medication recommendations implemented by physicians are more likely to achieve significant improvements in patient outcomes compared to those with lower implementation rates, which generally result in non-significant patient outcomes.
