Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
School of Health Sciences Blanquerna, University Ramon Llull, Barcelona, Spain.
J Am Med Dir Assoc. 2021 Dec;22(12):2518-2526. doi: 10.1016/j.jamda.2021.05.038. Epub 2021 Jul 3.
Pharmacists' care has an essential role in multidisciplinary teams in charge of chronic patients. However, data available on the clinical outcomes of these activities appear inconclusive. This study aimed to systematically investigate the effect of multidisciplinary teams that include coordinated pharmaceutical care on clinical outcomes.
Systematic review and meta-analysis. Relevant studies identified from MEDLINE, Cochrane, Web of Science, Scopus and CINAHL databases were analyzed. The search included randomized clinical trials published in 2000-2018. Included studies were all published studies in English that compared the effectiveness of multidisciplinary teams including pharmacist care to usual care. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity.
29 studies involving 4186 adult patients were included.
Follow-up time varied from 30 to 180 days. The most common primary endpoint was the frequency of hospitalizations or readmissions, followed by variation in clinical parameter variables related to quality of prescription, treatment adherence and costs.
Twelve (41.3%) of the included studies scored low risk of bias according to the AMSTAR-2 scale, the remaining 17 (58.7%) being classified as intermediate risk. The intervention of a multidisciplinary team reduced the probability of readmission by 32% [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.62-0.89]. Six of the 29 (20.7%) studies included met the inclusion criteria of the meta-analysis on quality-of-life outcomes. The intervention of the multidisciplinary team represented a significant increase in patients' quality of life (OR 0.58, 95% CI 0.47-0.69). Analysis of heterogeneity showed a significant difference between the studies. No evidence of publication bias was identified.
Multidisciplinary programs that include pharmaceutical care reduce the risk of visiting hospitals and improve patients' quality of life. This review supports the importance of the pharmacists as part of multidisciplinary teams.
药剂师的护理在负责慢性病患者的多学科团队中起着重要作用。然而，关于这些活动的临床结果的数据似乎尚无定论。本研究旨在系统地研究包括协调药物护理的多学科团队对临床结果的影响。
系统评价和荟萃分析。对 MEDLINE、Cochrane、Web of Science、Scopus 和 CINAHL 数据库进行了分析，以确定相关研究。搜索包括 2000 年至 2018 年发表的随机临床试验。纳入的研究均为比较包含药师护理的多学科团队与常规护理的有效性的英文出版研究。使用随机效应模型进行荟萃分析，并进行亚组分析以确定异质性的来源。
纳入了 29 项研究，涉及 4186 名成年患者。
随访时间从 30 到 180 天不等。最常见的主要终点是住院或再入院的频率，其次是与处方质量、治疗依从性和成本相关的临床参数变量的变化。
根据 AMSTAR-2 量表，12 项（41.3%）纳入研究的偏倚风险评分较低，其余 17 项（58.7%）为中级风险。多学科团队的干预可降低 32%的再入院概率[比值比（OR）0.74，95%置信区间（CI）0.62-0.89]。29 项研究中有 6 项（20.7%）符合生活质量结果荟萃分析的纳入标准。多学科团队的干预显著提高了患者的生活质量（OR 0.58，95%CI 0.47-0.69）。异质性分析表明，研究之间存在显著差异。未发现发表偏倚的证据。
包括药物护理的多学科方案可降低住院风险并提高患者的生活质量。本综述支持药剂师作为多学科团队成员的重要性。
