Sensitivity of Patient Outcomes to Pharmacist Interventions. Part I: Systematic Review and Meta-Analysis in Diabetes Management
- 1 October 2007
- journal article
- research article
- Published by SAGE Publications in Annals of Pharmacotherapy
- Vol. 41 (10), 1569-1582
- https://doi.org/10.1345/aph.1k151
Abstract
Background: Pharmacists participate in managing diabetes therapy. Despite many reviews, few have quantified the impact of pharmacists' interventions.Objectives: TO identity outcomes sensitive to pharmacists' interventions and quantify their impact through critical literature review.Methods: All original research describing the impact of pharmacists' interventions in the management of diabetic pharmacotherapy was sought in International Pharmaceutical Abstracts, MEDLINE, Embase, Cochrane Register, and Cumulative Index to Nursing & Allied Health Literature from inception through 2006. Two independent reviewers identified articles, compared results, and settled differences through consensus. The Downs-Black scale was used to assess quality. Data included intervention type, patient numbers, demographics, study characteristics, instruments used, data compared, and outcomes reported. A random-effects meta-analysis combined amenable results.Results: Of 302 articles identified, 108 involved pharmacists' interventions; 36 addressed diabetes (14 medical clinics, 11 community pharmacies, 7 ambulatory care clinics, 4 hospital wards, 1 physician's office, 1 prison, and 3 in both medical clinics and community pharmacies; 1 did not describe its practice site). Research designs included randomized (n = 18) and nonrandomized (n = 9) controlled trials, pre- and postobservational cohorts (n = 2), retrospective cohort study (n = 1), chart reviews (n = 5), and database study (n = 1). Diabetes education (69%) and medication management (61%) were the most frequently used Interventions. Mean ± SD quality was 62 ± 11% (fair). Fifty-one (69%) study results were sensitive, Meta-analysis of data from 2247 patients in 16 studies found a significant reduction in hemoglobin A1C(A1C) levels in the pharmacists' intervention group (1.00 ± 0.28%; p < 0.001) but not in controls (0.28 ± 0.29%; p = 0.335). Pharmacists' interventions further reduced A1C values 0.62 ± 0.29% (p = 0.03) over controls.Conclusions: A1C is sensitive to pharmacists' interventions. Several potentially sensitive outcomes were identified, but too few studies were available for quantitative summaries. More research is needed.Keywords
This publication has 38 references indexed in Scilit:
- Effects of Quality Improvement Strategies for Type 2 Diabetes on Glycemic ControlJAMA, 2006
- A Systematic Review of Interventions to Improve Diabetes Care in Socially Disadvantaged PopulationsDiabetes Care, 2006
- Implementation and Evaluation of Australian Pharmacists’ Diabetes Care ServicesJournal of the American Pharmacists Association, 2004
- Glycosylated Hemoglobin, Cardiovascular, and Renal Outcomes in a Pharmacist-Managed ClinicAnnals of Pharmacotherapy, 2004
- A randomised controlled trial of a pharmaceutical care programme in high-risk diabetic patients in an outpatient clinicInternational Journal of Pharmacy Practice, 2002
- The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventionsJournal of Epidemiology and Community Health, 1998
- The Rising Global Burden of Diabetes and its Complications: Estimates and Projections to the Year 2010Diabetic Medicine, 1997
- Self-Efficacy Theory as a Framework for Community Pharmacy-Based Diabetes Education ProgramsThe Diabetes Educator, 1996
- The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes MellitusThe New England Journal of Medicine, 1993
- The Combination of Estimates from Different ExperimentsBiometrics, 1954