58
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Effect of outpatient pharmacists' non‐dispensing roles on patient outcomes and prescribing patterns

      systematic-review
      , , , , , ,
      Cochrane Effective Practice and Organisation of Care Group
      The Cochrane Database of Systematic Reviews
      John Wiley & Sons, Ltd

      Read this article at

      ScienceOpenPublisherPMC
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          The roles of pharmacists in patient care have expanded from the traditional tasks of dispensing medications and providing basic medication counseling to working with other health professionals and the public. Multiple reviews have evaluated the impact of pharmacist‐provided patient care on health‐related outcomes. Prior reviews have primarily focused on in‐patient settings. This systematic review focuses on services provided by outpatient pharmacists in community or ambulatory care settings. This is an update of the Cochrane review published in 2000.

          Objectives

          To examine the effect of outpatient pharmacists' non‐dispensing roles on patient and health professional outcomes.

          Search methods

          This review has been split into two phases. For Phase I, we searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (January 1966 through March 2007). For Phase II, we searched MEDLINE/EMBASE (January 1966 through March 2008). The Phase I results are reported in this review; Phase II will be summarized in the next update.

          Selection criteria

          Randomized controlled trials comparing 1. Pharmacist services targeted at patients versus services delivered by other health professionals; 2. Pharmacist services targeted at patients versus the delivery of no comparable service; 3. Pharmacist services targeted at health professionals versus services delivered by other health professionals; 4. Pharmacist services targeted at health professionals versus the delivery of no comparable service.

          Data collection and analysis

          Two authors independently reviewed studies for inclusion, extracted data, and assessed risk of bias of included studies.

          Main results

          Forty‐three studies were included; 36 studies were pharmacist interventions targeting patients and seven studies were pharmacist interventions targeting health professionals. For comparison 1, the only included study showed a significant improvement in systolic blood pressure for patients receiving medication management from a pharmacist compared to usual care from a physician. For comparison 2, in the 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. For comparison 3, no studies were identified meeting the inclusion criteria. For comparison 4, two of seven studies demonstrated a clear statistically significant improvement in prescribing patterns.

          Authors' conclusions

          Only one included study compared pharmacist services with other health professional services, hence we are unable to draw conclusions regarding comparisons 1 and 3. Most included studies supported the role of pharmacists in medication/therapeutic management, patient counseling, 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. There was great heterogeneity in the types of outcomes measured across all studies. Therefore a standardized approach to measure and report clinical, humanistic, and process outcomes for future randomized controlled studies 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.

          Plain language summary

          Non‐traditional roles of outpatient pharmacists.

          The role of pharmacists in the community includes more than dispensing medications. It involves identifying, preventing, and resolving drug‐related problems, as well as encouraging proper use of medications and general health promotion and education.

          This review found forty‐three studies which evaluated non‐traditional roles of pharmacists. In general, the data included in this review supported the roles of pharmacists in patient counseling, therapeutic management, and providing health professional education with the goal of improving patient process of care and clinical outcomes. Non‐traditional roles of outpatient pharmacists improves health care outcomes. The data show that educational outreach visits may impact physician prescribing patterns.

          Related collections

          Author and article information

          Contributors
          berol@pharmacy.ucsf.edu
          Journal
          Cochrane Database Syst Rev
          Cochrane Database Syst Rev
          14651858
          10.1002/14651858
          The Cochrane Database of Systematic Reviews
          John Wiley & Sons, Ltd (Chichester, UK )
          1469-493X
          7 July 2010
          July 2010
          30 November 2010
          : 2010
          : 7
          : CD000336
          Affiliations
          University of California, San Francisco deptClinical Pharmacy 155 North Fresno Street, Suite 224 Fresno California USA 93701
          University of California, San Francisco deptClinical Pharmacy Suite 420, Box 0613 3333 California Street San Francisco California USA 94118
          Institut Central des Hopitaux Valaisans deptPharmacy Grand Champsec 86 CP 736 Sion Switzerland 1951
          University of Aberdeen deptDepartment of General Practice and Primary Care Foresterhill Health Centre Westburn Road Aberdeen UK AB25 2AY
          University of California San Francisco deptProfessor of Clinical Pharmacy & Health Policy Suite 420, Box 0613 3333 California Street San Francisco California USA 94143‐0613
          Article
          PMC7087444 PMC7087444 7087444 CD000336.pub2 CD000336
          10.1002/14651858.CD000336.pub2
          7087444
          20614422
          ec6ec1e1-38b1-4f65-9df0-46435ccef537
          Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
          History
          Categories
          Effective practice & health systems
          Delivery of healthcare services

          Comments

          Comment on this article

          Related Documents Log