Varas-Doval R, Saéz-Benito L, Gastelurrutia M A, Benrimoj S I, Garcia-Cardenas V, Martinez-Martínez F
Spanish General Pharmaceutical Council, Villanueva 11, 28001, Madrid, Spain.
Faculty of Health Sciences, San Jorge University, Villanueva de Gállego, Zaragoza, Spain.
BMC Health Serv Res. 2021 Feb 17;21(1):156. doi: 10.1186/s12913-021-06150-8.
Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting.
A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool.
The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes.
There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.
实施专业药学服务（PPS）需要证明该服务的影响（疗效）及其效果。多项系统评价和随机对照试验（RCT）已表明PPS在社区药房患者结局方面的疗效。然而，有必要通过务实试验来确定PPS在日常实践中的有效性证据水平。以识别和分析在社区药房环境中衡量PPS在临床、经济和人文结局方面有效性的务实RCT。
在MEDLINE、EMBASE、Cochrane图书馆和SCIELO中进行了系统检索。检索于2020年1月31日进行。根据以下纳入标准对论文进行评估：（1）干预可定义为PPS；（2）在社区药房环境中进行；（3）为原创论文；（4）报告了至少一项健康结局指标的定量测量（ECHO模型）；（5）设计被视为务实RCT，即它满足3个预定义属性。使用PRECIS-2工具分析外部有效性。
检索策略共检索到1587篇论文。共纳入12项评估5种不同类型PPS的务实RCT。12篇论文中有9篇在一项或多项主要结局（临床、经济或人文）上显示出统计学上的显著差异，这些差异可能与以下PPS相关：戒烟、配药/依从性服务、独立处方和药物治疗管理（MTM）。没有论文报告成本效益结局。
关于社区PPS有效性的现有证据有限。需要务实的RCT来评估PPS的临床、人文和经济结局。
