Positive impacts on a range of health factors

New research reveals community pharmacist-led interventions can positively impact on medication adherence, BP control, cholesterol management, COPD and asthma control

Researchers from the School of Pharmacy at The University of Auckland, New Zealand, recently conducted a systematic review looking into the effectiveness of community pharmacist-led interventions.

Their review, published this month in the International Journal of Pharmacy Practice, included 22 studies with outcomes reported in 26 peer-reviewed journal articles.

These were published from 1973 to 2015, and the majority were randomised controlled trials (n = 16). Most were from the US (n = 8) followed by Australia, Belgium and the Netherlands (n = 3 each).

All eligible studies evaluated the impact of a community pharmacist-led intervention on patients’ medication adherence (n = 22).

The review found community pharmacist-led interventions led to the improvement of patient adherence to medications.

It also found that such interventions can contribute to better blood pressure (BP) control, cholesterol management, COPD and asthma control.

However the findings did not report statistically significant effects of the interventions on glycated haemoglobin (HbA1c) levels or depression symptom control.

Timing of the intervention may play an important role in its success, say the authors Aleksandra Milosavljevic, Trudi Aspden and Jeff Harrison.

“Most of the interventions were delivered face-to-face and involved an educational component, to improve patients’ understanding of their medications or illnesses,” they say.

“Future research should attempt to better understand which components make the greatest contribution towards improving adherence and health outcomes, for patients with different medical conditions.”

The authors point out that most of the reviewed studies were unblinded and the pharmacist often delivered the intervention and assessed outcomes.

However these outcomes were often assessed using an objected measurement tool, which may have minimised potential effects of bias on the outcome.

See a summary of the results below:

Medication adherence: Out of 11 studies that reported a percentage of patients’ adherent to treatment as an outcomes, six showed a significantly higher proportion of intervention cohorts were adherent to their medications compared to controls. A total of 65 adherence outcomes were reported for the 22 studies, with 61.5% showing a statistically significant result (p < 0.05).

Blood pressure: Ten studies reported in 12 articles used BP measurements as a clinical outcome to assess the effectiveness of a community pharmacist-led intervention. Three studies found a significantly greater proportion of patients achieved their goal BP in the intervention group compared with the control group. Four found a significantly greater reduction in systolic BP (SBP) in the intervention groups compared with the control.

HbA1c and blood glucose levels: Three studies described the impact of community pharmacist-led interventions on patients’ HbA1c levels and on blood glucose levels. The findings were mixed, with one study reporting a significant difference between groups while for the remaining two did not.

Blood lipids and cholesterol levels: Of two studies, one found the intervention group significantly lowered their non-fasting cholesterol levels over the study period, while the control group did not. A second study found a significant difference in mean LDL-C levels between the intervention and controls groups, favouring the intervention arm.

Respiratory disease control: Of four studies, one found improvements in asthma control scores in patients with insufficiently controlled asthma at baseline, as well as a significant decrease in night time awakening in the intervention group. A second study found the proportion of intervention patients with severe asthma significantly declined during the study, while the proportion in the control group did not.

A third study found a significantly lower frequency of severe exacerbations in the intervention group compared with the control group, as well as significantly lower estimated annual rates of severe exacerbations.

Symptoms of depression: Zero out of three studies found a significant difference in depressive symptom control between intervention and control groups at the end of the study period.

Hospital visits: While six studies reported the effect of community pharmacist intervention on patient hospitalisation rates, only three of 13 outcomes showed statistically significant improvements. In the diabetic cohort, the percentage of patients visiting the ED was significantly lower in the intervention group. Another study found a significant reduction in the annual hospitalisation rate (rate ratio: 0.28, p=0.03) as well as the number of hospitalisation days (rate ratio: 0.27, p<0.0001) in the intervention group.

Knowledge about medication and/or illness: Three out of six studies reported significantly greater patient knowledge in the intervention group at the end of the study.

Patient satisfaction: Six out of six studies reported on patient satisfaction with the particular intervention, while some incorporated satisfaction with general pharmacy services as well.

See the full review here

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