Shedding light on the evidence

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Pharmacist interventions can achieve clinically relevant improvements for patients, but better quality of evidence is needed in the future, says Cochrane review lead author

There is a need for better detailed reporting in future trials on pharmacist services and interventions, says the lead author of a recent Cochrane systematic review.

Researchers from the Universities of Bath, Aberdeen, Brunel, California and Nottingham Trent, working with Cochrane and NHS Education Scotland, compared pharmacist interventions with usual care for a wide range of chronic conditions including diabetes and high blood pressure.

Their review looked at 111 trials (39,729 participants) comparing pharmacist interventions with usual care, of which 76 were included in meta‐analyses.

The most common settings in which the pharmacists delivered their interventions were community pharmacies and primary care practices or clinics, hospital outpatient clinics and specialist clinics.

Other settings included the patient’s home including telephone follow‐up, as well as community settings.

Compared with usual care, the researchers were uncertain whether pharmacist services improved the percentage of patients outside the glycolated haemoglobin target range (very low‐certainty evidence).

Pharmacist services may make little or no difference to hospital attendance or readmission (moderate‐certainty evidence) or to adverse drug effects (low‐certainty evidence).

Pharmacist services may, however, reduce the percentage of patients whose blood pressure is outside the target range (low‐certainty evidence) and may also slightly improve physical functioning (low‐certainty evidence).

Professor Margaret Watson from the University of Bath, who led the review, said: “What is really important about this review is that it shows pharmacist services can achieve clinically relevant improvements for patients and could lead to benefits for some long term conditions, particularly diabetes and high blood pressure.

“We know that these types of long-term conditions are going to increase as the population ages.

“There has been huge government investment in placing pharmacists in general practices and elsewhere in the NHS [National Health Service in the UK]. The results of this review indicate that trials of pharmacist services may produce improvements in patient health. As such, future investment in pharmacist services could be informed by the results of this review.”

However, Professor Watson added: “Pharmacists are not a panacea, but they can increase capability and capacity within the healthcare system and help patients to improve their health.

“There are some caveats. Due to poor reporting of the details from some trials and overall low quality of evidence, we can’t pinpoint the specific elements of a pharmacist service that is having an effect,” she said.

“So we would like to see much better detailed reporting in future trials.”

Of the five studies that compared services delivered by pharmacists with other health professionals, no studies evaluated the impact of the intervention on the percentage of patients outside blood pressure or glycated haemoglobin target range, hospital attendance and admission, adverse drug effects, or physical functioning.

Professor Watson said: “This indicates that there is no evidence to suggest that interventions delivered by other health professionals, are more or less beneficial than those delivered by pharmacists.”

See the Cochrane review here

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