Efficacy and Safety of Pharmacist-Led Medication Therapy Management in Patients with Multimorbidity: A Systematic Review

Abstract

Background: Multimorbidity contributes to treatment burden and medication-related harm in adults. Pharmacist-led services address these challenges, but evidence remains heterogeneous.
Aim: To synthesise evidence on pharmacist-led medication management for adults with multimorbidity and integrate core components into a logic model.
Method: PubMed, CINAHL, Scopus, and Cochrane were searched (inception–22 Aug 2025) for empirical studies on pharmacist-led medication management in adults with multimorbidity. Two reviewers screened and assessed quality using RoB 2, JBI, MMAT, Drummond, and COSMIN; narrative synthesis was used due to heterogeneity in designs and outcomes.
Results: Pharmacist-led care may improve intermediate clinical outcomes (low certainty) and medication appropriateness (moderate certainty), but evidence for utilisation and economic effects is very uncertain. A logic model synthesises core activities and implementation enablers, mapping pathways to clinical, safety, and utilisation outcomes to guide service design and scale-up. To optimise practice, pharmacists should have EHR access and dependable workflows; future studies should use core outcome sets and report fidelity to strengthen comparability.
Conclusion: Pharmacist-led medication management may improve selected intermediate clinical outcomes (low certainty) and medication appropriateness (moderate certainty); evidence for utilisation and economic outcomes remains very uncertain. The logic model supports service design and scale-up. To optimize practice, pharmacists should be integrated into care pathways with electronic record access and dependable workflows; future research should use core outcome sets and report implementation fidelity to improve comparability.