School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK.
Syst Rev. 2021 Mar 31;10(1):92. doi: 10.1186/s13643-021-01586-9.
Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness.
A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool.
A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data.
Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies.
PROSPERO CRD42018086411.
与一般人群相比，患有严重精神疾病（例如精神分裂症）的个体的预期寿命缩短了 20%。由于心脏代谢风险和代谢综合征，心血管疾病导致了大部分超额死亡。广泛搜索表明，尚未对有关药剂师在严重精神疾病个体的心脏代谢风险、代谢综合征及相关疾病（例如 2 型糖尿病）方面的作用的已发表研究进行综述。
进行了一项混合方法系统评价。使用全面的搜索策略在 11 个数据库中进行搜索，以确定英语研究，其中药剂师参与了任何来源国家任何研究环境中针对严重精神疾病的心脏代谢风险、代谢综合征或相关疾病的干预。首先，进行了映射综述。然后，使用 Cochrane 有效实践和护理组织分类法对实施研究干预的策略进行分类。如果可能（对于报告的定量结果参数，获取了统计显著性检验），分析研究干预对过程（例如代谢综合征的诊断率）和临床（例如糖尿病控制）结局的影响。使用改良的混合方法评价工具进行质量评估。
共确定了 33 项研究。所有特征均显示研究存在异质性。共有 20 项研究报告了定量结果数据，可对研究干预的影响进行详细分析。使用的实施策略总数与测量结果的影响之间的关系尚不清楚。在实施干预措施时纳入面对面互动似乎非常重要，即使单独使用也会对测量结果产生具有统计学意义的积极影响。很少有研究将药剂师纳入社区或全科医生实践（n=2）、临床结局、实施干预后的个体随访（n=3）中。没有研究包括定性数据的综合。
我们的研究结果表明，当作为唯一策略使用时，涉及药剂师与多学科团队其他成员进行面对面互动的实施策略可以改善过程结局。需要进一步开展关于临床结局（例如心血管风险降低）、社区药剂师的作用和定性研究的工作。
PROSPERO CRD42018086411。
