Impact of clinical pharmacy interventions on health and economic outcomes in type 2 diabetes: A systematic review and meta-analysis.

Abstract

To examine the effectiveness of clinical pharmacy interventions on health and economic outcomes of people with type 2 diabetes in hospital settings. We searched MEDLINE, EMBASE, PsycInfo, CINAHL, COCHRANE Library and citations and reference lists of key articles. We included randomized and non-randomized controlled trials, cohort and controlled before-after studies. Primary outcomes were glycosylated haemoglobin (HbA1c ), all-cause mortality, major cardiovascular events, adverse events (AEs), health-related quality of life and economic outcomes. We retrieved 11,853 studies, of which 44 studies were included in the review (n=8623). We included 29 randomized controlled studies in the meta-analyses (n=4055). Clinical pharmacy interventions significantly reduced HbA1c levels compared to usual care (standardized mean difference: -0.52, p<0.001). The interventions significantly reduced AEs compared to usual care. No studies were reported on the effectiveness of clinical pharmacy interventions on major cardiovascular events. In one study that examined the impact of clinical pharmacy interventions on all-cause mortality, a non-significant reduction was observed compared with usual care. There was significant improvement in quality of life and significant reduction in costs of type 2 diabetes care compared to usual care. Clinical pharmacy interventions were effective in improving glycaemic control, quality of life and reducing the rate of AEs and costs of type 2 diabetes care.