|مجال التميز||تميز دراسي وبحثي|
Impact of the pharmacist‐led intervention on the control of medical cardiovascular risk factors for the primary prevention of cardiovascular disease in general practice: A systematic review and meta‐analysis of randomised controlled trials
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Aims: To conduct a systematic review and meta‐analysis of the effectiveness of general practice‐based pharmacist interventions in reducing the medical risk factors for the primary prevention of cardiovascular events.
Methods: A systemic search was undertaken in 8 databases: PubMed, MEDLINE, EMBAS, PsycINFO, Cochrane Library, CINAHL Plus, SCOPUS and Science Citation Index, with no start date up to 27 March 2019. Randomised controlled trials assessing the effectiveness of pharmacist‐led interventions delivered in the general practice in reducing the medical risk factors of cardiovascular events were included in the review. The risk of bias in the studies was assessed using the Cochrane risk of bias tool.
Results: A total of 1604 studies were identified, with 21 randomised controlled trials (8933 patients) meeting the inclusion criteria. Fourteen studies were conducted in patients with diabetes, 7 in hypertension, 2 involving dyslipidaemia, and 2 with hypertension and diabetes together. The most frequently used interventions were medication review and medication management. The quality of the included studies was variable. Patients receiving pharmacist‐led interventions were associated with a statistically significant reduction in their systolic blood pressure (−9.33 mmHg [95% Confidence Interval (CI) −13.36 to −5.30]), haemoglobin A1C (−0.76% [95% CI −1.15 to −0.37]) and low‐density lipoprotein–cholesterol (−15.19 mg/dL [95% CI −24.05 to −6.33]). Moreover, practice‐based pharmacists’ interventions were also reported to have a positive impact on patient adherence to medications.
Conclusion: The findings of this review suggest that pharmacist‐led interventions in general practice can significantly reduce the medical risk factors of cardiovascular disease events. These findings support the involvement of pharmacists as healthcare providers in managing patients with hypertension, diabetes and dyslipidaemia.
Health Services Research & Pharmacy Practice Conference 2019
Pharmacist Interventions in Prevention of Cardiovascular Diseases in General Practice: A Systematic Review of Randomized Controlled Trials
Introduction: Hypertension, diabetes and dyslipidaemia are significant risk factors leading to CVDs, which continues to be a leading cause of death worldwide. Pharmacists’ working in GP surgeries are integrating their expertise’ and skills to help improve the quality of care for both patients and the healthcare system.
Aims/objectives: This study aimed to provide a comprehensive review of the effectiveness of pharmacist interventions in general practice in preventing cardiovascular events focusing on clinical impact, adherence to medication, and economic outcomes.
Research design and methodology: A systemic search of the literature was undertaken in eight electronic databases: PubMed (NCBI), Ovid MEDLINE (1946), EMBASE (1974), PsycINFO (1967), Cochrane library (Wiley), CINAHL Plus (EBSCO) (1937), SCOPUS (ELSEVIER) and Science Citation Index Expanded (Web of Science Core Collection) (1900) from inception to February 2018. Studies were included if they were randomised controlled trials or cluster-randomised trials assessing the effectiveness of interventions delivered in general practice by only or mainly a pharmacist. The pharmacist interventions were included if they were patient focused interventions including at least one of the medical cardiovascular disease risk factors, mainly hypertension, type 2 diabetes mellitus and dyslipidaemia. Studies were included if they had a comparison with usual care. The risk of bias in included studies was assessed using the Cochrane risk of bias tool.
Results: A total of 1536 articles were initially identified, with 20 meeting inclusion criteria. 13 studies were conducted in patients with diabetes, 7 studies in patients with hypertension, 2 studies in patients with dyslipidaemia and two trials studied patients with hypertension and diabetes together. All studies included had a low risk of reporting bias and about 10%-25% were at high risk of bias for detection, and attrition. Performance bias was unclear in 75% of the included studies. The most frequent interventions were medication review in all studies (100%) followed by medication management (90%) and then patient educational interventions (75%). Practice-based pharmacist interventions showed a positive effect on reduction of blood pressure, HbA1c; the prediction of 10-year CHD risk and by the enhancement of lipid profiles during the follow-up period in the intervention groups from baseline to final follow-up and/or compared with control groups. In addition, Practice-based pharmacist interventions also had a positive effect on medication adherence in all trials. Lastly, only 4 studies conducted an economic analysis, Practice-based pharmacist interventions evidenced to be cost effective.
• This systematic review and meta-analysis provide evidence that general practice-based pharmacists can deliver several direct multifaceted interventions. These interventions can have a significant effect on reducing CVD events in patients with hypertension, diabetes and dyslipidaemia.
• Pharmacist interventions can effectively enhance medication adherence and be cost-effective.
عبدالله علي سالم الشهري
الطب والخدمات الصحية