Community Pharmacist-led Intervention Research Articles

Using design thinking to strengthen the community pharmacist’s role in epilepsy care

ObjectiveTo use design thinking to develop a community pharmacist-led intervention for people living with epilepsy (PWE) with desirable, feasible, and viable features. MethodsThis study used design thinking. Three patient personas were created based on previous research: a newly diagnosed PWE, a well-controlled PWE, and a complex PWE with uncontrolled seizures. An intervention prototype was developed for each of the three personas. Structured interviews were conducted with pharmacists, pharmacy students, patients with diagnosed epilepsy, and caregivers to elicit feedback on which features of each intervention prototype were desirable, feasible, and viable. Interviews were analyzed using rapid content analysis. A multidisciplinary advisory group and the research team prioritized features of the prototypes to include in the final intervention. ResultsThe following four features were identified as desirable, feasible, and viable for a pharmacist-led intervention for PWE: (1) pharmacist-patient consultations, (2) care plan development, (3) regular check-ins, and (4) care coordination with other health care providers. SignificanceThis study identified evidence-based features for a community pharmacist intervention to support epilepsy care using design thinking. A pilot study to evaluate this intervention on the quality of life (QoL), health outcomes and satisfaction of PWE can inform the implementation and feasibility of such patient services.

Effectiveness of community pharmacist-led interventions in osteoarthritis pain management: A cluster-randomized trial

BackgroundCommunity pharmacists contribute in osteoarthritis management via evidence-based pain management services. However, their roles and impacts on osteoarthritis management in low- and middle-income countries have yet to be explored. ObjectiveThis study aims to evaluate the effectiveness of community pharmacist-led educational intervention and medication review among osteoarthritis patients. MethodsA 6-month cluster-randomized controlled study was conducted in 22 community pharmacies of Nepal. Patients clinically diagnosed with osteoarthritis, aged 18 years and above, with a poor knowledge level of osteoarthritis and pain management were enrolled in the study. The intervention groups were educated on osteoarthritis and pain management, and had their medications reviewed while control group received usual care. Primary outcomes evaluated for the study were the change in pain levels, knowledge, and physical functional scores at 3 and 6 months. Repeated analyses of covariance were performed to examine the outcomes. ResultsA total of 158 participants were recruited for the study. The intervention group reported improvements in pain score (mean difference 0.473, 95 % CI 0.047 to 0.900) at 3 months and the end of the study (mean difference 0.469, 95 % CI 0.047 to 0.891) as compared to control. Similarly, improvement in knowledge scores were observed in the intervention group at 3 months (mean difference 5.320, 95 % CI 4.982 to 5.658) and 6 months (mean difference 5.411, 95 % CI 5.086 to 5.735). No differences were observed in other outcomes, including physical functional score, depression, and quality of life. ConclusionCommunity pharmacist-led intervention improved patients’ knowledge of osteoarthritis and pain management. While pain scores improved, physical functional score, depression, and quality of life score remained unchanged. Trial registrationClinicalTrials.gov identifier: NCT05337709.

Medication-related problems identified by community pharmacists: a descriptive case study of two Australian populations

BackgroundMedication-related problems (MRPs) contribute significantly to preventable patient harm and global healthcare expenditure. Vulnerable populations, including Indigenous Australians (please note that the use of the term ‘Indigenous’ in this paper includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures.) and people living with severe and persistent mental illness (SPMI), may be at increased risk of MRPs. Pharmacist-led medication reviews can identify MRPs for targeted action.ObjectiveTo characterize MRPs identified and recommendations made by community pharmacists during medication reviews conducted with Indigenous Australians and people living with SPMI.MethodsParticipants were recruited through two Australian trials testing the feasibility and/or effectiveness of novel community pharmacist-led interventions, the Indigenous Medication Review Service (IMeRSe) feasibility study (June 2018–July 2019) and Bridging the Gap between Physical and Mental Illness in Community Pharmacy (PharMIbridge) randomized controlled trial (September 2020–December 2021). Trained community pharmacists conducted medication reviews responsive to the cultural and health needs of participants. MRPs, MRP severity and pharmacist recommendations were documented and classified using an established classification system (DOCUMENT). MRP severity was assessed by pharmacists and an independent assessor. Data were analysed descriptively, and paired t-tests were used to compare severity ratings.ResultsPharmacists identified 795 MRPs with 411 participants across both trials (n = 255 IMeRSe, n = 156 PharMIbridge). Non-adherence to medication was the most common (n = 157, 25.1%) and second-most common (n = 25, 14.7%) MRP in IMeRSe and PharMIbridge, respectively. Undertreatment was the second-most common MRP in the sample of Indigenous Australians (n = 139, 22.2%), and reports of toxicity/adverse reactions were most common in people living with SPMI (n = 41, 24.1%). A change in pharmacotherapy was the most frequent recommendation made by pharmacists (40.2% and 55.0% in IMeRSe and PharMIbridge, respectively). Severity ratings varied, with the majority being ‘Mild’ or ‘Moderate’ in both groups. Significant differences were found in the severity rating assigned by trial pharmacists and the independent assessor.ConclusionsCommunity pharmacists identified a range of MRPs experienced by two at-risk populations, most commonly non-adherence and toxicity or adverse reactions, when conducting medication reviews and proposed diverse strategies to manage these, frequently recommending a change in pharmacotherapy. These findings highlight the opportunity for more targeted approaches to identifying and managing MRPs in primary care and tailored community pharmacist-led interventions may be of value in this space.Trail Registration: Australian and New Zealand Clinical Trial Registry records (IMeRSe ACTRN12618000188235 registered 06/02/2018 & PharMIbridge ACTRN12620000577910 registered 18/05/2020).

THE PHARMACISTS’ AND MOBILE APPLICATIONS’ ROLE IN THE TREATMENT OF HYPERTENSION

Objective: Poor adherence is the main reason for inadequate blood pressure control. Pharmacists are highly accessible healthcare professionals, and it has been reported that community pharmacist-led interventions improved patients’ BP control and outcomes. Some authors reported on the beneficial effects of mobile applications on better drug adherence. The aim of this study was to identify subjects in the general population who may benefit from such interventions. Design and method: A total of 1228 subjects enrolled in the EHUH 2 study (a random sample, nationwide survey) and 424 participants of the Hunt on the Silent Killer (HSK) (opportunistic screening on islands) were included in this analyses. The same questionnaire was applied containing questions about health issues, therapy, habits, and opinion on pharmacists’ and mobile applications’ (MA) role in hypertension treatment. Results: The binomial logistic regression analysis showed a significant model when comparing positive and negative answers for the following: the participants were more likely to be in favour of pharmacists’ role if they had a positive history of angina pectoris ( = 1.333, p = 0.016), diabetes mellitus ( = 1.125, p < 0.001), dyslipidemia ( = 1.326, p < 0.001), or being treated for hypertension ( = 1.326, p < 0.001) in the HSK, and in the EHUH 2 study if they suffered a stroke (100%). Socio-demographic factors had no impact on the pharmacists’ role in the general population. However, at islands significantly enhanced negative responses in case of lower household income (35%), married state (29%) and employed subjects (17%) were observed. The participants were more likely to be in favour of MA if they had a positive history of hypertension, have higher income and were married. Interestingly, the history of cardiovascular diseases indicated more negative responses. Conclusions: The participants were generally in favour of MA, which may confirm the need to digitalise the healthcare system, but it was more enhanced in participants with a higher socio-demographic status. Pharmacists-led interventions (lifestyle support and adherence increasing programs) have to be individualized.

A review and narrative synthesis of community pharmacist-led interventions to tackle medicines for pain that are misused.

To undertake a state-of-the-art review and narrative synthesis of current evidence investigating community pharmacist-led interventions addressing analgesic medication misuse. To achieve the objective, a systematic database search was undertaken during October and November 2020 across Embase, Medline, Web of Science and Scopus. Community pharmacy interventions were mapped to the Behaviour Change Wheel to investigate the pharmacist and patient behaviours addressed by the interventions. Outcomes about process and effects were extracted. A risk of bias assessment was undertaken. Five studies undertaken in the USA and Northern Ireland were included. Brief Motivational Interviewing and Medication Therapy Management and the Opioid and Naloxone Education programme demonstrated positive process outcomes and feasibility in delivery. Intervention functions addressing patient and pharmacist behaviours across the studies included education, training, environmental restructuring and enablement. Restrictions were an additional intervention function targeting patient behaviour incorporated in one study. Pharmacist roles involved the identification of potential misusers/abusers, patient education, long-term management, prevention and referral. Low study numbers, non-experimental designs, high risk of bias, incomplete reporting of interventions and heterogeneous outcome measures limited evidence synthesis. There is limited evidence of pharmacy interventions and their well-tested impact on pharmacists and patients. There is clinical and methodological heterogeneity across studies. It is pragmatic to suggest that a systems-thinking approach is adopted to investigate the potential role of community pharmacists and engage all stakeholders in the design of a theory-informed intervention. More high-quality studies including larger population sizes undertaken for longer periods of time that are rigorously reported are needed to improve the evidence base.

Community pharmacist-led interventions, cardiovascular disease and medication adherence: a systematic review of randomised controlled trials

Abstract Introduction Medication adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57% (1). Interventions to tackle nonadherence are important for improving health-related outcomes. Pharmacist-led interventions may have the potential to improve medication adherence and clinical outcomes in patients with CVD. Aim This study aimed to assess the impact of community pharmacist-led interventions on improving medication adherence and clinical outcomes in patients with CVD. This review also explores the characteristics of the interventions and the actual content of the interventions. Methods This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (2). The protocol was registered in the PROSPERO database (CRD42021250361). Four electronic databases (MEDLINE (Ovid), PubMed Central, PsycINFO (Ovid), and Cochrane library) were systematically searched for randomised controlled trials (RCTs), assessing the impact of pharmacist-led interventions on medication adherence in patients in CVD. RCTs were filtered for English language from inception to April 2021 and duplicate removed. Screening and selection of titles, abstracts, and full text was followed by data extraction and risk of bias assessed using the Cochrane Risk of Bias tool. A narrative synthesis was performed. Ethical approval was not required. Results Searches yielded 564 citations, of which 145 duplicates were removed. The title and abstract screening resulted in 16 full-text review studies. Of these, 8 studies were excluded. Therefore, this study included 8 RCTs, published between 2007 and 2019, conducted in different countries. The sample sizes were small for most RCTs (ranged from 225 to 1906). The range of CVD targeted was diverse: 3 included patients with dyslipidaemia, 2 with heart failure, 3 with hypertension. The most frequent pharmacist-led interventions (7 out of 8 RCTs) were multifaceted context and included medication reviews and adherence counselling; the intervention duration ranged from 2 to 12 months. The interventions were conducted in a primary care setting: 6 in pharmacies, one in a clinic, and one within a home visit. A total of five RCTs reported medication adherence as the primary outcome, and three reported clinical outcomes. RCTs used different measurements to assess adherence, 3 used self-reported and 5 used pharmacy refill records. Seven of the RCTs reported that interventions enhanced medication adherence, with 3 showed statistically significant improvements at 6 months and 12 months of the intervention. Five RCTs assessed the effect of the interventions on the clinical outcomes and reported a trend toward improvement in blood pressure and low-density lipoprotein cholesterol level in the intervention arm. Regarding the quality of evidence, most RCTs were classified as having poor quality because of the high risk of bias or insufficient reporting of information. Conclusion Pharmacist-led interventions tend to improve medication adherence and clinical outcomes, but interventions varied in terms of content and delivery. The precise design of the interventions with essential characteristics tailored to patients’ needs could increase the effectiveness of these interventions. Further large RCTs are required. Limitations of this review include the exclusion of non-English language studies. Further, the clinical and methodological heterogeneity of included studies made clear a quantitative comparison difficult, thus, the findings are based on narrative analysis. References (1) Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125(9):882-7.e1. (2) Yepes-Nuñez JJ, Urrútia G, Romero-García M, Alonso-Fernández S. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed). 2021;74(9):790-9.

A systematic literature review and meta-analysis of community pharmacist-led interventions to optimise the use of antibiotics.

AimsThe aim of this systematic review is to assess the effects of community pharmacist‐led interventions to optimise the use of antibiotics and identify which interventions are most effective.MethodsThis review was conducted according to the PRISMA guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context, and be pharmacist‐led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient‐reported outcomes. Risk of bias was assessed using the ‘Cochrane suggested risk of bias criteria’ and narrative synthesis of primary outcomes conducted.ResultsSeventeen studies were included covering in total 3822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, 12 on secondary outcomes and two on both. Three studies reported improvements in quality of dispensing, interventions led to more intensive symptom assessment (up to 30% more advice given) and a reduction of over‐the‐counter supply up to 53%. Three studies led to higher consumer satisfaction, effects on adherence from nine studies were mixed (risk difference 0.04 [−0.02, 0.10]). All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies.ConclusionsOur review suggests some positive results from pharmacist‐led interventions, but the interventions do not seem sufficiently effective as currently implemented. This review should be interpreted as exploratory research, as more high‐quality research is needed.

Effectiveness of Community Pharmacist-Led Intervention for Patients with Dyslipidemia Using the Rubric-Based Intervention Program: A Randomized Controlled Trial

Effectiveness of Community Pharmacist-Led Intervention for Patients with Dyslipidemia Using the Rubric-Based Intervention Program: A Randomized Controlled Trial

Community Pharmacist-Led Interventions to Improve Preconception and Pregnancy Health: A Systematic Review.

Background: Community pharmacist-led interventions are effective in improving health outcomes; however, their impact in improving preconception and pregnancy health is not clear. This study evaluated the effectiveness of community pharmacist-led interventions which aimed to improve health outcomes of preconception and pregnant women. Methods: A systematic review of the literature, consistent with PRISMA guidelines, was performed. Five electronic databases were searched up to February 2021. Results: Four studies, three in pregnant women and one in preconception women, were identified. The studies focused on improving micronutrient status and smoking cessation. The studies increased knowledge about, and use of, iron supplements, and improved iron status and smoking cessation rates in pregnant women, while improving knowledge regarding, and increasing the use of, preconception folic acid. The studies were ranked as weak to moderate quality. Conclusion: This review provides preliminary evidence for the potential benefit of community pharmacist-led interventions to improve the health of women before and during pregnancy.

Pharmacy-led interventions successful in deprescribing of high-risk medication, review suggests

Community pharmacist-led interventions can lead to successful deprescribing of high-risk medication, as well as improving quality of life in patients with severe mental illness, a review published in the British Journal of Clinical Pharmacology has suggested. Researchers carried out a review of 24 studies, investigating community pharmacy-led deprescribing interventions in a total of 4,231 adults. […]

Impact of community pharmacist-led interventions in chronic disease management on clinical, utilization, and economic outcomes: An umbrella review

Chronic disease represents a significant burden to the United States (US) health care system, with approximately 50% of all adults in the US having one or more chronic disease conditions. Pharmacist-led chronic disease management interventions are of special interest since 80% of medical treatments involve the use of prescription drugs. Moreover, community pharmacists are among the most accessible health care professionals to provide care for populations with chronic diseases. The impact of care provided by community pharmacists isn't well defined, with interventions taking on diverse forms with varied effects on outcomes. The purpose of this review is to summarize evidence from secondary literature on community pharmacist-led chronic disease management interventions and the impact on clinical, utilization, and economic outcomes. We conducted a systematic search of systematic reviews, meta-analyses, and narrative reviews using MEDLINE via PubMed, EMBASE.com and Cochrane Library databases published between January 1, 2007 and October 17, 2017. The following data were extracted: citation details, review type, number of primary studies included, disease state, description of the intervention, outcomes assessed, and results. Our search strategy retrieved 2296 titles and abstracts of which 15 references met our inclusion criteria. Selected articles covered 7 main diseases -diabetes, asthma, chronic obstructive pulmonary disease (COPD), hypertension, heart failure, hyperlipidemia, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Community pharmacist-led interventions mostly consisted of patient consultations and education. In diabetes, interventions achieved significant reductions in hemoglobin A1c, total cholesterol, and low-density lipoprotein (LDL). Reviews also reported favorable reductions in blood pressure, improved medication adherence and reduced readmission rates in patients with heart failure, improved lung function in patients with respiratory conditions, and increased medication adherence in those with HIV/AIDs. Literature reporting economic and utilization outcomes were limited and mostly focused on pharmacy interventions in diabetes. In some cases, community pharmacy services demonstrated a decrease in medical and health care costs in patients with diabetes. We found that community pharmacists can improve clinical outcomes in a wide array of chronic diseases, including diabetes, hyperlipidemia, HIV/AIDS, cardiovascular and respiratory diseases. More robust studies are needed to further assess the impact of specific interventions on economic and utilization outcomes.

A Cost Analysis and Cost-Utility Analysis of a Community Pharmacist–Led Intervention on Reducing Cardiovascular Risk: The Alberta Vascular Risk Reduction Community Pharmacy Project (RxEACH)

BackgroundA randomized trial (the Alberta Vascular Risk Reduction Community Pharmacy Project) showed that a community pharmacist-led intervention was efficacious for reducing cardiovascular (CV) risk. However, the cost of this strategy is unknown. ObjectivesWe examined the short- and long-term cost of a pharmacist-led intervention to reduce CV risk compared to usual care. MethodsWe conducted a trial-based cost analysis from the perspective of a publicly funded healthcare system. Over 3 and 12 months of follow-up, we examined specific intervention costs (pharmacy claims), related intervention costs (laboratory tests and medications), and ongoing healthcare costs (physician claims, emergency department visits, and hospital admissions). We also used the validated CV Disease Policy Model–Canada to estimate the long-term effects. ResultsA total of 684 participants (mean age 62, 57% male) were included. Overall, there were no significant differences in healthcare costs at 3 or 12 months between the usual care and intervention groups (P = .127). The CV disease-related healthcare cost of managing a patient over a lifetime was estimated to be Can$45 530 (95% uncertainty interval [UI], 45 460-45 580) and Can$40 750 (95% UI, 37 780-43 620) in usual care and intervention groups, respectively, an incremental cost savings of Can$4770 per patient (95% UI, 1900-7760). The intervention dominated usual care (better outcomes and lower costs) across 3-year, 5-year, 10-year, and lifetime horizons. ConclusionThis economic analysis suggests that a clinical pathway-driven pharmacist-led intervention (previously shown to reduce CV risk) was associated with similar measured healthcare costs over 1 year, and lower extrapolated healthcare costs over a patient lifetime. This strategy could be broadly implemented to realize its benefits.

An Analysis of the Impact of Clinical Pharmacist Intervention on Adherence in Medicaid Patients with Diabetes

Antibiotic resistance is one of the world's most pressing public health problems, resulting in over 23,000 deaths per year. One of the main contributing factors to antimicrobial resistance is antibiotic misuse and overuse. Community pharmacists can play a role in reducing antibiotic resistance, since they are one of the most accessible healthcare professionals.The purpose of this paper is to describe community pharmacy interventions and strategies to reduce antibiotic misuse and overuse and to discuss the implications for pharmacy training.A narrative overview strategy was employed to identify papers on antibiotic stewardship and the role of the community pharmacist. Our review examined potential stewardship strategies and interventions within community pharmacy practice that provide opportunities for pharmacists to engage or lead in the reduction of antimicrobial resistance.We describe five promising community pharmacist-led intervention strategies: Collaborative Practice Agreements (CPAs), point-of-care (POC) testing, patient consultations, academic detailing and serving as an advocate for patients and other healthcare providersThis review highlights topics that may warrant increased attention in pharmacy school curricula. Pharmacy schools may want to consider modifying their curricula to address the shifts in practice of the community pharmacist – emphasizing the expanded role of the pharmacist in patient care and public health issues such as outpatient antibiotic stewardship.

Community pharmacy interventions to improve antibiotic stewardship and implications for pharmacy education: A narrative overview

Antibiotic resistance is one of the world's most pressing public health problems, resulting in over 23,000 deaths per year. One of the main contributing factors to antimicrobial resistance is antibiotic misuse and overuse. Community pharmacists can play a role in reducing antibiotic resistance, since they are one of the most accessible healthcare professionals. The purpose of this paper is to describe community pharmacy interventions and strategies to reduce antibiotic misuse and overuse and to discuss the implications for pharmacy training. A narrative overview strategy was employed to identify papers on antibiotic stewardship and the role of the community pharmacist. Our review examined potential stewardship strategies and interventions within community pharmacy practice that provide opportunities for pharmacists to engage or lead in the reduction of antimicrobial resistance. We describe five promising community pharmacist-led intervention strategies: Collaborative Practice Agreements (CPAs), point-of-care (POC) testing, patient consultations, academic detailing and serving as an advocate for patients and other healthcare providers CONCLUSIONS: This review highlights topics that may warrant increased attention in pharmacy school curricula. Pharmacy schools may want to consider modifying their curricula to address the shifts in practice of the community pharmacist - emphasizing the expanded role of the pharmacist in patient care and public health issues such as outpatient antibiotic stewardship.

Community pharmacist-led interventions and their impact on patients' medication adherence and other health outcomes: a systematic review.

Medication adherence can be defined as the extent to which one's medication-taking behaviour follows that mutually agreed upon by the prescribing physician. Optimal medication adherence is often deemed crucial for the success of a patient's treatment, as suboptimal adherence may lead to treatment failure and unnecessary medical expenditure. Increasing evidence has highlighted the positive contribution community pharmacist-led interventions can have on improving patients' adherence and health outcomes. To provide an overview of the published literature on community pharmacist-led interventions and their effectiveness in improving patients' adherence and health outcomes. A search strategy was developed, aiming to retrieve published reports of community pharmacy interventions worldwide. Medline, EMBASE, International Pharmaceutical Abstracts, Google Scholar and ProQuest Dissertations and Theses databases were searched. Articles meeting the inclusion criteria were collated, relevant data extracted, and a risk of bias assessment undertaken. Twenty-two studies were included in the analysis, and their outcomes were reported in 26 peer-reviewed journal articles. Community pharmacist-led interventions have been shown to improve patients' adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control. Studies in this review, however, did not report statistically significant effects of interventions on diabetes or depression control. Community pharmacist-led interventions have been shown to contribute to improved adherence and better disease control. Future research should attempt to better understand which particular intervention components make the greatest contribution towards improving adherence and health outcomes, for patients with different medical conditions.

Effective Interventions for Diabetes Patients by Community Pharmacists: A Meta-analysis of Pharmaceutical Care Components.

To evaluate randomized controlled trials (RCTs) that included interventions provided by community pharmacists for patients with type 1 and 2 diabetes, the analysis of each component of the intervention(s), and the description of the training that the pharmacists received. The literature research was conducted in PubMed and in the Cochrane Central Register of Controlled Trials (January 2000 to April 2016) for RCTs with interventions provided by community pharmacists for patients with diabetes. Corresponding authors were contacted about missing data and intervention and training design. RCTs published in English or German were included if pharmaceutical care or medication therapy management was conducted by community pharmacists with diabetes patients. Basic information, intervention and training design data were extracted. The literature research resulted in 11 eligible studies for further analysis. The corresponding authors of 6 studies responded to our request and sent their raw data. The calculated meta-analytical effect of 640 analyzed patients was a hemoglobin A1C (A1C) difference of -0.66%, with a 95% CI of -0.86% to -0.45%. The analysis revealed that most intervention elements had a significant positive meta-analytical effect on the A1C values. Our meta-analysis suggests that community pharmacist-led interventions can improve glycemic control in patients with type 1 and 2 diabetes. The most effective intervention components were patient centered and interdisciplinary. Pharmaceutical care interventions should, therefore, include the following components: sending feedback to the physician, setting individual goals, reviewing medication, and assessing patients' health beliefs and medication knowledge.

Pharmacist-to-prescriber intervention to close therapeutic gaps for statin use in patients with diabetes: A randomized controlled trial

ObjectiveTo assess the effect of a community pharmacist-led intervention on the proportion of patients with diabetes placed on statin therapy. DesignThe Pharmacy Quality Alliance endorsed a performance measure, Statin Use in Persons with Diabetes, which evaluates the percentage of patients aged 40-75 years who were dispensed a medication for diabetes and also received a statin medication. SettingThis new measure has been implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard. ParticipantsIn this randomized controlled study, eligible patients identified in EQuIPP are those who received medications from a large chain community pharmacy in North Carolina, are 40-75 years, had ≥2 prescription fills of a diabetes medication, and were not receiving statin therapy. InterventionThe control group received no intervention. Primary care prescribers of patients in the intervention group were contacted by phone and fax to obtain a prescription for an appropriate statin. Main outcome measuresThe primary outcome was the proportion of patients in each group who were dispensed a statin, calculated using Fisher exact test. Sub-analyses were performed to control for patient age, sex, and insurance type. ResultsThe number of statins prescribed was statistically significant between intervention group (n = 221) versus control group (n = 199) with 46 statins versus 17 statins, respectively (P <0.001). The number of statins dispensed was also statistically significant between groups with 34 statins in the intervention group versus 15 statins in the control group (P = 0.015). The fourth most common (9.2%) reason prescribers rejected statin therapy initiation was “Patient has normal cholesterol” and this caused the greatest amount of discussion between pharmacist and prescriber. ConclusionThrough a brief pharmacist-to-provider intervention, a significant gap closure in statin therapy was seen in patients with diabetes. There is an opportunity for pharmacies, health plans, and prescribers to utilize the community pharmacist in achieving quality, evidence-based patient care.

The impact of interventions by pharmacists in community pharmacies on control of hypertension: a systematic review and meta-analysis of randomized controlled trials.

To undertake a systematic review and meta-analysis of randomized controlled trials concerned with the impact of community pharmacist-led interventions on blood pressure control in patients with hypertension. Eight electronic databases were searched up to 30 November 2013, with no start date (Web of Science, Embase, The Cochrane Library, Medline Ovid, Biomed Central, Biosis Citation Index, CINAHL, PsycINFO). All studies included were randomized controlled trials involving patients with hypertension, with or without cardiovascular-related co-morbidities, with difference in blood pressure as an outcome. Data collected included the study design, baseline characteristics of study populations, types of interventions and outcomes. The Cochrane tool was used to assess risk of bias. From 340 articles identified on initial searching, 16 randomized controlled trials (3032 patients) were included. Pharmacist-led interventions were patient education on hypertension, management of prescribing and safety problems associated with medication, and advice on lifestyle. These interventions were associated with significant reductions in systolic [11 studies (2240 patients); -6.1 mmHg (95% confidence interval, -3.8 to -8.4 mmHg); P < 0.00001] and diastolic blood pressure [11 studies (2246 patients); -2.5 mmHg (95% confidence interval, -1.5 to -3.4 mmHg); P < 0.00001]. Community pharmacist-led interventions can significantly reduce systolic and diastolic blood pressure. These interventions could be useful for improving clinical management of hypertension.

The effectiveness of a community pharmacist-led intervention to improve screening for sleep apnea in primary care – A cohort study

Despite the high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. In many developed countries, because community pharmacists (CP) are easily accessible, they have been developing additional clinical services that integrate the services of and collaborate with other healthcare providers (general practitioners (GPs), nurses, etc.). Alternative strategies for primary care screening programs for OSAS involving the CP are discussed. We aimed to determine whether the involvement of a CP in the care pathway of a patient at risk for OSAS, through the implementation of a GP-CP collaborative intervention, was effective that is to say if it improved the detection rate and diagnosis of the disease in this population. Setting: 31 community pharmacies in 5 regions in France. Participants: Patients at risk for OSAS, i.e taking 1 or more anti- hypertensive drugs, being overweight (BMI > 25), snoring nearly every night. Intervention: The CP intervention consisted in (i) a discussion with the patient on the risks and comorbidities associated with untreated OSAS, (ii) guiding the patient to fill in the Berlin Questionnaire and the Epworth Sleepiness Scale and (iii) encouraging the patient to consult his/her referent GP with the questionnaires results and urging the doctor, in a letter written to his/her intention, to continue investigations. Measurement: Proportion of patients who had performed a diagnostic test for OSAS. 782 Patients were analysed (88 patients exposed and 694 patients unexposed). After a 6 months follow-up, the number of patients who had performed a diagnostic test for OSAS was significantly higher in the exposed group compared to the unexposed group (22.7% versus 11.4%, p = 0.003). Being exposed to the CP intervention was associated with a higher chance of having a diagnostic test for OSAS, (adjusted OR: 2.34 [1.26–4.35]). These findings provide arguments for the implementation of a CP-GP collaborative OSAS screening intervention in community pharmacy routine practice. Future research should focus on potential economic benefits of such an intervention. We would like to thank the Ordre National des Pharmaciens and all the community pharmacists who participated in this study for their support in this new adventure.

Pharmacist-Based Medication Review Reduces Potential Drug-Related Problems in the Elderly

The high prevalence of drug-related problems (DRPs) in the elderly, occurring as a result of multiple drug use combined with age-related changes in pharmacokinetics and pharmacodynamics, is a well known phenomenon. However, effective intervention strategies are uncommon. A pharmacy-based controlled trial (SMOG [Screening Medicatie Oudere Geneesmiddelgebruiker; Screening Medications in the Older Drug User]) was performed to investigate whether a community pharmacist-led intervention reduces the number of potential DRPs in patients aged > or = 65 years using six or more drugs concomitantly. This intervention study was conducted from June 2002 until June 2003 in 16 community pharmacies in the Netherlands. Medication assessment was undertaken in elderly patients aged > or = 65 years using six or more drugs concomitantly on the date of inclusion. Ten types of potential DRPs were determined and grouped into the following three categories: (i) patient-related potential DRPs: non-compliance; (ii) prescriber-related potential DRPs: expired indication, therapeutic duplication, inappropriate dosage (over- and under-dosage), off-label use, undertreatment, inconvenience of use; and (iii) drug-related potential DRPs: contraindications, drug-drug interactions, drug treatment of adverse drug reactions. A list of recommended changes in medication was compiled by the pharmacist for the patients in the intervention group. Recommendations for medication change were discussed with the general practitioner (GP). Four months after the date of inclusion, the medications of each patient were again reviewed and screened for potential DRPs. The primary outcome corresponded to the change in the number of potential DRPs; the secondary outcome was related to the change in number of used medications between the intervention group and the control group at baseline and 4 months later. A total of 174 patients were analysed: 87 patients in the intervention arm and 87 patients in the usual care arm. After a 4-month period, we observed a significant reduction in the mean number of DRPs per patient (mean difference -16.3%; 95% CI -24.3, -8.3). The mean number of drugs per patient was not significantly reduced (mean difference -4.7%; 95% CI -9.6, 0.2). This study showed a positive influence of the community pharmacist in reducing potential DRPs in the elderly. Future interventions should also focus on actual outcomes, including quality of life, morbidity and mortality.