Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
Institute of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
Res Social Adm Pharm. 2018 Mar;14(3):228-240. doi: 10.1016/j.sapharm.2017.04.014. Epub 2017 Apr 22.
A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispensing pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success.
This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care.
In this literature review we searched two electronic databases and the reference list of published literature reviews for studies about clinical pharmacy services performed by non-dispensing pharmacists physically co-located in primary care practice. We assessed the degree of integration via key dimensions of integration based on the conceptual framework of Walshe and Smith. We included English language studies of any design that had a control group or baseline comparison published from 1966 to June 2016. Descriptive statistics were used to correlate the degree of integration to health outcomes. The analysis was stratified for disease-specific and patient-centered clinical pharmacy services.
Eighty-nine health outcomes in 60 comparative studies contributed to the analysis. The accumulated evidence from these studies shows no impact of the degree of integration of non-dispensing pharmacists on health outcomes. For disease specific clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 55%, 57% and 70%.
Full integration adds value to patient-centered clinical pharmacy services, but not to disease-specific clinical pharmacy services. To obtain maximum benefits of clinical pharmacy services for patients with multiple medications and comorbidities, full integration of non-dispensing pharmacists should be promoted.
非发药药剂师开展临床药学服务，旨在优化患者的个体化药物治疗。在基层医疗实践中嵌入非发药药剂师可以促进合作，可能会提高患者的护理水平。非发药药剂师融入多学科医疗团队的程度在不同环境中差异很大。整合程度可能是其成功的决定因素。
本研究调查非发药药剂师的整合程度如何影响基层医疗中的药物相关健康结果。
在本次文献综述中，我们搜索了两个电子数据库和已发表文献综述的参考文献，以寻找关于在基层医疗实践中物理上共同定位的非发药药剂师提供临床药学服务的研究。我们通过基于 Walshe 和 Smith 概念框架的整合关键维度来评估整合程度。我们纳入了任何设计的英语语言研究，这些研究有对照组或基线比较，并于 1966 年至 2016 年 6 月发表。使用描述性统计数据将整合程度与健康结果相关联。分析按疾病特异性和以患者为中心的临床药学服务进行分层。
60 项比较研究中有 89 项健康结果有助于分析。这些研究的综合证据表明，非发药药剂师整合程度对健康结果没有影响。对于疾病特异性临床药学服务，无、部分和完全整合的非发药药剂师的健康结果改善比例分别为 75%、63%和 59%。对于以患者为中心的临床药学服务，无、部分和完全整合的非发药药剂师的健康结果改善比例分别为 55%、57%和 70%。
完全整合为以患者为中心的临床药学服务增加了价值，但对疾病特异性临床药学服务没有影响。为了使患有多种药物和合并症的患者从临床药学服务中获得最大收益，应促进非发药药剂师的完全整合。
