Abstract / Summary
Background/Objectives: Polypharmacy may increase the risk of medication discrepancies, drug–drug interactions, potentially inappropriate prescribing, nonadherence, adverse drug events, and avoidable healthcare use. Telemedicine may improve access to medication review, particularly for older adults, people with multimorbidity, and geographically underserved populations. This review evaluated the effectiveness, safety, acceptability, and implementation requirements of telemedicine-enabled medication optimization and considered implications for Saudi Vision 2030. Methods: This PRISMA 2020 systematic review searched PubMed/MEDLINE, Europe PMC, and ClinicalTrials.gov from inception to 30 June 2026. Eligible studies evaluated telemedicine-supported medication reconciliation, medication therapy management, deprescribing, adherence support, or clinical-pharmacy consultation in adults with polypharmacy or explicitly defined high medication risk. Two reviewers independently screened records and extracted data. Clinical and methodological heterogeneity required narrative synthesis. Results: The search identified 168 records; 52 duplicates were removed, 12 reports underwent full-text assessment, and eight studies were included. Green et al. randomized 69 patient-care-partner dyads to immediate or delayed pharmacist telehealth deprescribing; approximately 80% in each arm completed the intervention, but changes in total medication count and regimen complexity were small and the latter was not clinically meaningful. Cole et al. reported 30-day readmission in 12/76 pharmacist-contacted patients and 3/12 patients who declined or could not be reached (p = 0.529); this nonrandomized comparison does not establish a reduction in readmissions. Process outcomes, including identification of discrepancies, interactions, and potentially inappropriate medicines, were more consistently favorable than clinical outcomes. Certainty was low for detection of medication-related problems and very low or absent for most clinical, utilization, and economic outcomes. Conclusions: Telemedicine-enabled medication optimization appears feasible, but evidence of clinical effectiveness and cost savings remains uncertain. Saudi implementation should begin with monitored pilots emphasizing safety, equity, Arabic-language accessibility, governance, and prospective evaluation. Registration: This completed review was retrospectively registered on the Open Science Framework (OSF).