Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America.
Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America.
PLoS One. 2020 Dec 3;15(12):e0243134. doi: 10.1371/journal.pone.0243134. eCollection 2020.
Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST).
To identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review.
Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%).
This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.
系统评价和荟萃分析估计药房支持干预对出院患者中不适当酸抑制治疗（AST）比例的影响。
为了确定研究，于 2018 年 10 月 14 日和 2019 年 9 月 12 日系统地在以下数据库中进行了检索：Ovid MEDLINE（R）和在处理和其他非索引引文及每日、Embase.com、CINAHL、Web of Science、Cochrane 中心（EBSCO）和 ClinicalTrials.gov。合格的研究包括成年人、干预和历史/常规护理组、活性药房支持干预的描述以及不适当 AST 出院患者的比例。进行了定性评估和定量分析。修正的漏斗图分析评估了异质性。本综述中使用了系统评价和荟萃分析的首选报告项目（PRISMA）方法学来评估研究。
综述纳入了 17 篇文献，共 16 项研究。使用随机效应模型，荟萃分析显示，与对照组相比，药师支持干预组出院时接受不适当 AST 的几率显著降低（优势比 0.33 [95%CI 0.20 至 0.53]），且存在显著异质性（I2=86%）。11 项研究支持药房支持干预，4 项研究结果不确定，1 项研究支持常规护理。使用修正的漏斗图分析，我们的最终评价浓缩到 11 项研究，结果相似（OR 0.36 [95%CI 0.27 至 0.48]），但异质性较小（I2=36%）。
本系统评价和荟萃分析表明，药房支持干预与出院患者接受不适当 AST 的概率显著降低相关。然而，异质性较高，可能影响结果的解释。使用漏斗图优化方法，客观地从分析中排除了三项阳性和两项阴性研究，结果显示效应大小相似，但异质性较小。为了提高研究质量，未来的研究人员应考虑采用预-后、多臂、前瞻性设计，随机抽样，培训数据提取者（最好两名提取者），重新评估小数据集以检查一致性，并在后续出版物中提供全面的方法。
