***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Heart failure has become one of the major causes of hospitalization worldwide . Hypertension , diabetes mellitus and hyperlipidemia are the major causes of heart failure . In order to effectively prevent heart failure , blood pressure , blood glucose and cholesterol levels shall be closely monitored and controlled as well as medication adherence . This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in high risk elderly patients in the community of Hong Kong . Aim This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in highrisk elderly patients in the community of Hong Kong . Methods This prospect i ve uncontrolled study was conducted between July 2012 and April 2013 with two revisits every 3 to 4 months to review elderly patients ’ medication profiles as well as assess their blood pressure ( BP ) , r and om capillary blood glucose ( RCBG ) level , cholesterol levels , signs and symptoms of heart failure and the compliance level . The results collected at the baseline data were analyzed and compared with those collected at the last follow-up visit . Result A significant increase in number of subjects free of symptoms of heart failure ( 31.88 % , p < 0.001 ) was found . For chronic disease management , significant reduction in LDL-cholesterol level ( -0.86 ± 0.56mmol/L , p = 0.038 ) and triglyceride level ( -1.15 ± 1.09mmol/L , p < 0.001 ) was observed in overall participants . Yet , no significant reduction in BP level or RCBG level was observed in overall subjects . Significant reduction in mean Morisky Medication Adherence Score ( -0.54 ± 1.50 , p = 0.005 ) indicated improvement in medication compliance in participants . Conclusion The Pharmacy Outreach service has a significant role in prevention of heart failure , by means of minimizing heart failure symptoms , improving medication compliance and enhancing chronic disease management , particularly cholesterol management in community elderly patients . This study provided a reference for further investigation and evaluation of the role of pharmacists in preventing heart failure in the high-risk community elderly patients Aim : To measure the outcomes of a harmonised , structured pharmaceutical care programme provided to elderly patients by community pharmacists . Method : A r and omised , controlled , longitudinal , clinical trial with repeated measures was performed over an 18‐month period , involving  community pharmacies ( 5 intervention and 5 control ) in Northern Irel and . Elderly , ambulatory patients ( ≥ 65 years ) , taking 4 or more prescribed medications were eligible for participation . Patients attending an intervention pharmacy received education on medical conditions , implementation of compliance strategies , rationalising of drug regimens and appropriate monitoring ; patients attending control sites received normal services . A battery of clinical , humanistic and economic outcomes were assessed . Results : A significantly higher proportion of intervention patients were compliant at the end of the 18‐month study and experienced fewer problems with medication compared to control patients ( P < 0.05 ) . There was little impact on quality of life and health care utilisation . Conclusions : Pharmaceutical care provision to community‐dwelling patients result ed in an improvement in medication compliance and evidence of cost‐savings . Future pharmaceutical care studies may benefit from a more focussed selective approach to data collection and outcomes measurement Background Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes . Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice . The aim of this study was to assess the effect of a tailored program to improve the implementation of three important processes of care for this patient group : ( a ) structured medication counseling including brown bag review s , ( b ) the use of medication lists , and ( c ) structured medication review s to reduce potentially inappropriate medication . Methods We conducted a cluster-r and omized controlled trial with a follow-up time of 9 months . Participants were general practitioners ( GPs ) organized in quality circles and participating in a GP-centered care contract of a German health insurance . Patients aged > 50 years , suffering from at least 3 chronic diseases , receiving more than 4 drugs , and being at high risk for medication-related events according to the assessment of the treating GP were enrolled . The tailored program consisted of a workshop for GPs and health care assistants , educational material s and reminders for patients , and the elaboration of implementation action plans . The primary outcome was the change in the degree of implementation between baseline and follow-up , measured by a summary score of 10 indicators . The indicators were based on structured surveys with patients and GPs . Results We analyzed the data of 21 GPs ( 10 - intervention group , 11 - control group ) and 273 patients ( 130 - intervention group , 143 - control group ) . The increase in the degree of implementation was 4.2 percentage points ( 95 % confidence interval : −0.3 , 8.6 ) higher in the intervention group compared to the control group ( p = 0.1 ) . Two of the 10 indicators were significantly improved in the intervention group : medication counseling ( p = 0.017 ) and brown bag review ( p = 0.012 ) . Secondary outcomes showed an effect on patients ’ self-reported use of medication lists when buying drugs in the pharmacy ( p = 0.03 ) . Conclusions The tailored program may improve implementation of medication counseling and brown bag review whereas the use of medication lists and medication review s did not improve . No effect of the tailored program on the combined primary outcome could be substantiated . Due to limitations of the study , results have to be interpreted carefully . The factors facilitating and hindering successful implementation will be examined in a comprehensive process evaluation . Trial registration numberIS RCT N34664024 , assigned Introduction An ageing population has become an urgent concern for Asia in recent times . In nursing homes , polypharmacy has also become a compounding issue . Deprescribing practice is an evidence -based strategy to provide a better outcome in this group of patients ; however , its implementation in nursing homes is often challenging , and prospect i ve outcome data on deprescribing practice in the elderly is lacking . Our study assesses the implementation of team-care deprescribing to underst and the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice . Methods and analysis This multicentre prospect i ve study consists of a pre study interview question naire , and a preintervention and postintervention study to be conducted in the nursing home setting on residents at least 65 years old and on five or more medications . We will employ a cluster r and omised stepped-wedge interventional design , based on a five-step ( review ing , checking , discussion , communication and documentation ) team-care deprescribing practice coupled with the use of a deprescribing guide ( consisting of Beers and STOPP criteria , as well as drug interaction checking ) , to assess the health and pharmacoeconomic outcome in nursing homes ’ practice . Primary outcome measures of the intervention will consist of fall risks using a fall risk assessment tool . Other outcomes assessed include fall rates , pill burden including number of pills per day , number of doses per day and number of medications prescribed . Cost-related measures will include the use of cost – benefit analysis , which is calculated from the medication cost savings from deprescribing . For the pre study interview question naire , findings will be analysed qualitatively using thematic analysis . Ethics and dissemination This study is approved by the Domain Specific Review Board of National Healthcare Group , Singapore ( 2016/00422 ) and Monash University Human Research Ethics Committee ( 2016 - 1430 - 7791 ) . The study findings shall be disseminated in international conferences and peer- review ed publications . The study is registered with Clinical Trials.gov ( NCT02863341 ) , Pre- BACKGROUND AND PURPOSE In patients with hypertension , medication adherence is often suboptimal , thereby increasing the risk of ischemic heart disease and stroke . In a r and omized trial , we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients . Motivational interviewing was a key element of the intervention . METHODS Patients ( n = 532 ) were recruited from 3 hospital outpatient clinics and r and omized to usual care or a 6-month pharmacist intervention comprising collaborative care , medication review , and tailored adherence counseling including motivational interviewing and telephone follow-ups . The primary outcome was composite medication possession ratio ( MPR ) to antihypertensive and lipid-lowering agents , at 1-year follow-up , assessed by analyzing pharmacy records . Secondary outcomes at 12 months included persistence to medications , blood pressure , hospital admission , and a combined clinical endpoint of cardiovascular death , stroke , or acute myocardial infa rct ion . RESULTS At 12 months , 20.3 % of the patients in the intervention group ( n = 231 ) were nonadherent ( MPR < 0.80 ) , compared with 30.2 % in the control group ( n = 285 ) ( risk difference -9.8 ; 95 % confidence interval [ CI ] , -17.3 , -2.4 ) and median MPR ( interquartile range ) was 0.93 ( 0.82 - 0.99 ) and 0.91 ( 0.76 - 0.98 ) , respectively , P = .02 . The combined clinical endpoint was reached by 1.3 % in the intervention group and 3.1 % in the control group ( relative risk 0.41 ; 95 % CI , 0.11 - 1.50 ) . No significant differences were found for persistence , blood pressure , or hospital admission . CONCLUSIONS A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension . The intervention had no significant impact on blood pressure and secondary clinical outcomes STUDY OBJECTIVE To test the feasibility and effectiveness of an individualized Medication Assessment and Planning ( iMAP ) program integrated within a primary care practice on the number and prevalence of medication-related problems ( MRPs ) and acute health services utilization , defined as combined hospitalizations and emergency department visits . DESIGN Six-month , prospect i ve , observational pilot study . SETTING Community-based primary care medical practice . PATIENTS Convenience sample of 64 patients aged 65 years and older who were taking at least five medications . INTERVENTION Each patient was enrolled in the iMAP program-a collaborative , multifaceted intervention facilitated by a clinical pharmacist whereby patients receive comprehensive medication therapy management at baseline and 3 and 6 months as part of routine clinical care . MEASUREMENTS AND MAIN RESULTS MRPs were assessed and recommendations proposed using the previously published MRP classification tool ; physician acceptance of recommendations served to vali date the assessment s. There was a significant reduction in mean number of MRPs/patient ( 4.2 at baseline vs 1.0 at 6 mo , p<0.0001 ) when adjusted for number of medications , race , and pharmacist . The prevalence of MRPs at 6 months compared with baseline was also significant ( p<0.0008 ) . Acute health services utilization was assessed by medical record abstract ion . The 64 patients experienced a rate of 8.3 events/100 person-months ( 64 total events ) during the 12-month pre study period . During the 6-month study period , the same patients experienced 5.4 events/100 person-months ( 20 total events ) . Thus , we noted a reduction in acute health services utilization of 35 % . Physicians were enthusiastically supportive of iMAP . CONCLUSION iMAP has the potential to address a significant and timely issue affecting older adults and primary care practice s : the burden of managing and continuously monitoring multiple medications in medically complex older adults . A more rigorous evaluation of iMAP is warranted and planned to demonstrate sustained effectiveness and cost-benefit Background Drug related problems ( DRPs ) are impairing patients ’ health and cause high costs . Neither delegation of home medication review nor regular pharmaceutical care are common in Germany . Objective We aim ed to reduce several DRP by the implementation of a three party healthcare team [ AGnES- practice assistant , pharmacist , general practitioner ( GP ) ] and adherence supporting strategies ( using a medication reminder chart , medication compliance aid ) . Setting The setting was ambulatory primary healthcare in German rural areas with a cohort of home-dwelling , elderly , mostly multimorbid patients with limited mobility ( study period : 06/2006–12/2008 ) . Methods We conducted a prospect i ve non-r and omized implementation cohort study with home medication review ( home medication review module ; mean participation time : 9 months ) . Data collection was delegated to additionally qualified AGnES- practice assistants ( AGnES : GP-supporting , community-based , e-health-assisted systemic intervention ) . The intervention comprised pharmaceutical care by the local pharmacy in addition to medical interventions by the GP .  408 patients ( mean age : women : 80.7 years ; men : 75.3 years ) received both pharmaceutical care and at least one follow-up visit . Main outcome measurement Outcome measurements comprised self-reported DRPs , objective ly evaluated DRP , and prevalence of adherence supporting strategies . Results The three party healthcare team approach reduced self-reported forgetfulness ( 7.7–3.2 % ; p = 0.001 ) , the proportion of patients with intermittent drug intake ( 5.3–1.3 % ; p < 0.001 ) , and the proportion of patients with potentially clinical relevant drug – drug interaction ( 
    Output:
    
Conclusions There is insufficient evidence to show that deprescribing improves medication adherence .
Older people are particularly susceptible to non-adherence due to multi-morbidity associated with polypharmacy .
Bio-psycho-social factors including health literacy and multi-disciplinary team interventions influence adherence .