THE IMPACT OF PHARMACISTS' INTERVENTIONS- SENSITIVITY ON PATIENT OUTCOMES IN HYPERLIPIDEMIA MANAGEMENT
Author(s)
Márcio Machado, PhD, Post Doctoral Fellow, Jana Bajcar, MSc, Associate Professor, Nermine Nassor, BPharm, BPharm student, Thomas R. Einarson, PhD, Associate ProfessorUniversity of Toronto, Toronto, ON, Canada
Objective: Hyperlipidemia increases the risk for cardiovascular disease and control is pivotal for preventing subsequent complications. Multidisciplinary interventions, including pharmacists, are important for improving patients' outcomes. Our objective was to quantify the impact of pharmacist interventions in enhancing patients' clinical and humanistic outcomes. Methods: Two reviewers searched International Pharmaceutical Abstracts, Medline, Embase, The Cochrane Central Register of Controlled Trials, 3rd Quarter and CINAHL for pharmacist interventions in hyperlipidemia. Quality was assessed using Downs-Black scale. Data extracted included patients enrolled, study characteristics, intervention type and pre- and post-intervention measures for LDL, HDL, triglycerides, total cholesterol, adherence and quality-of-life. A random-effects meta-analysis combined data between pharmacist-intervention and standard-care groups. Chi-square tested heterogeneity of effects. Publication bias was assessed using funnel plots and Begg-Mazumdar statistic. Results: Fifty-one studies were found; 22 met inclusion/exclusion criteria. Study settings included medical clinic/center (n=11), community pharmacy (n=8), hospital (n=2) and patient homes (n=1). Patient education (77%) and medication management (73%) were most common interventions. The average patient follow-up period was 9.8 ± 6.4 months. Quality of pharmacist-intervention studies was considered “fair” (65%, SD=6.6%). Total cholesterol was significantly reduced from baseline (34.3±10.3 mg/dL, p<0.001) and also significantly above control groups (22.0±10.4 mg/dL, p=0.034). LDL was reduced significantly from baseline (38.6±12.4mg/dL, p=0.002); but not significantly more than controls (22.1±12.0 mg/dL, p=0.065). A clinically relevant but not statistically significant reduction in triglycerides was found. Patients' adherence to pharmacotherapeutic regimens (3/9 studies reported significant results after pharmacists' interventions) and quality of life (2/2 significant) were considered possibly not sensitive and possibly sensitive to pharmacist interventions, respectively. Conclusion: Total cholesterol is sensitive to pharmacist's interventions while LDL and triglycerides levels are possibly sensitive to those interventions. Further research should evaluate specific determinants of pharmacist-sensitive outcomes.
Conference/Value in Health Info
2008-05, ISPOR 2008, Toronto, Ontario, Canada
Value in Health, Vol. 11, No. 3 (May/June 2008)
Code
PCV5
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders