Three selected systematic reviews interesting for pharmacy practice research
| Title and reference | Results and discussion | Authors’ conclusion |
|---|---|---|
| Medication review in hospitalised patients to reduce morbidity and mortality Cochrane systematic review (Christensen and Lundh15). | A total of 4647 references were identified and five trials (1186 participants) were included. We found no evidence of effect on all-cause mortality and hospital readmissions, but a 36% relative reduction in emergency department contacts. It is uncertain whether medication review reduces mortality or hospital readmissions, but medication review seems to reduce emergency department contacts. However, the cost-effectiveness of this intervention is not known and due to the uncertainty of the estimates of mortality and readmissions and the short follow-up, important treatment effects may have been overlooked. It should be noted that this review has been criticised for choosing inappropriate outcomes. It also reports that medication review is largely ineffective whereas at best there is a lack of evidence either way. | Medication review should preferably be undertaken in the context of clinical trials. High quality trials with long follow-up are needed before medication review should be implemented |
| Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review (Graabaek and Kjeldsen13). | A total of 836 research papers were identified, and 31 publications were included in the study: 21 descriptive studies and 10 controlled (6 RCT) studies. The pharmacist interventions were well implemented with acceptance rates from 39% to 100%. The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use. Several outcomes were statistically insignificant, but these were predominantly associated with low sample sizes or low acceptance rates | Future research should be designed using rigorous design, large sample sizes and includes comparable outcome measures for patient health outcomes |
| Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns. Cochrane systematic reviews (Nkansah16). | A total of 43 studies were included; 36 were interventions targeting patients and 7 were targeting health professionals. One study showed a significant improvement in systolic blood pressure for patients receiving medication management from a pharmacist compared to usual care from a physician. Five studies evaluating process of care outcomes, pharmacist services reduced the incidence of therapeutic duplication and decreased the total number of medications prescribed. Twenty-nine of 36 studies reported clinical and humanistic outcomes. Pharmacist interventions resulted in improvement in most clinical outcomes, although these improvements were not always statistically significant. Eight studies reported patient quality of life outcomes; three studies showed improvement in at least three subdomains. Two of seven studies demonstrated a clear statistically significant improvement in prescribing patterns. Most included studies supported the role of pharmacists in medication/therapeutic management, patient counselling, and providing health professional education with the goal of improving patient process of care and clinical outcomes, and of educational outreach visits on physician prescribing patterns. | A standardised approach to measure and report clinical, humanistic, and process outcomes for future RCT evaluating the impact of outpatient pharmacists is needed. Heterogeneity in study comparison groups, outcomes, and measures makes it challenging to make generalised statements regarding the impact of pharmacists in specific settings, disease states, and patient populations |
RCT, randomised controlled trial.