Abstract
BackgroundThe pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists’ clinical roles in improving Pakistani patients’ therapeutic, safety, humanistic, and economic outcomes.MethodsWe searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed.ResultsThe literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions.ConclusionsThe findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients’ health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.
Highlights
The pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes
The findings revealed that pharmacist services improve treatment outcomes such as hyperglycemia and systolic blood pressure (SBP), diastolic blood pressure (DBP), cholesterol control, and the quality of life of people living with chronic diseases such as asthma, diabetes, and hypertension [31]
Study selection The search strategy identified original research studies on the effect of clinical pharmacists’ interventions on therapeutic, safety, humanistic and cost-effective consequences of pharmacist intervention compared to usual care without pharmacist involvement in direct patient care in the Pakistani setting
Summary
The pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes. In developing countries, pharmacists’ roles are gradually shifting toward ward rounds with other health professionals to monitor the patient’s progress, drug-related issues and communicate a medication therapy management plan [5,6,7]. They continue to be primarily responsible for manufacturing, distributing, and dispensing medicines [3, 8]. Clinical pharmacists can offer patients a wide range of services, including prescription drugs and healthrelated services [9, 10] They can assist physicians in prescribing drugs rationally, ensuring that patients understand the dosage regimen and method of administration, and improving patient adherence [11]. Pharmacists play an important role in public health promotion at community pharmacy settings, such as tobacco and alcohol control, nutrition and a healthy lifestyle, routine immunisation, infection prevention and treatment, and the management of mental health and other chronic disease care [12,13,14]
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