Large review finds positive pharmacy impact


Community pharmacy-based interventions most likely have a positive effect on health behaviours, intermediate clinical outcomes and quality of life in patients, Cochrane review finds

The Cochrane review set out to determine whether health‐promoting activities delivered in pharmacies are worthwhile and effective.

Reviewers analysed 57 randomised trials with 16,220 participants, described in 83 reports.

The trials were of health‐promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health‐related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy.

Most interventions were educational, or incorporated skills training, and most (n = 49) were conducted in high-income countries, with no studies in low-income countries.

Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36).

The review found moderate‐certainty evidence that health‐promotion interventions probably lead to a slight improvement in health‐related behaviours of pharmacy patients when compared to usual treatment.

Behaviours included medication adherence, quitting smoking, inhaler technique, alcohol consumption, diabetes self-care, physical activity and activity impairment.

Moderate‐certainty evidence showed community pharmacy interventions probably also lead to an improvement in intermediate clinical outcomes such as levels of hypertension or blood glucose for pharmacy patients.

However interventions probably made little or no difference for asthma control or for cardiovascular risk, the review found.

Reviewers identified no studies that evaluated the impact of health‐promotion interventions on event‐based clinical outcomes, such as stroke or myocardial infarction, or the psychological well‐being of pharmacy users.

They found health‐promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (moderate‐certainty evidence).

Meanwhile health‐promotion interventions were also found to probably improve pharmacy workers’ behaviour (moderate‐certainty evidence) when compared to no intervention. These studies typically assessed behaviour using mystery shopper methodology.

“Many people find health‐related lifestyle and self‐management behaviours difficult,” say the authors.

“Community pharmacies are an easy place for many people to access healthcare advice. In the past this advice was limited to how best to take medicines, but, increasingly, community pharmacy workers are carrying out other activities, such as giving advice on healthy eating and management of long‐term conditions,” they say.

“Pharmacies may be convenient for people to use, but it is important to understand whether health‐promoting activities delivered in pharmacies are worthwhile and effective, so that those responsible for commissioning health care can decide whether it is worth spending resources to support them.”

Based on the results, health promotion interventions in the community pharmacy context probably have positive effects and such interventions are likely to be cost‐effective, they say.

“The effects are seen across a range of clinical conditions and health‐related behaviours.

“The variety of studies includes different countries, conditions, interventions and outcomes, and suggests there is great interest in using the community pharmacy setting for workers to promote health‐related behaviours.”

The research was published in the Cochrane Database of Systematic Reviews

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