Strathclyde Institute of Pharmacy and Biomedical Science, Robertson Trust Wing, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, United Kingdom.
Strathclyde Institute of Pharmacy and Biomedical Science, Robertson Trust Wing, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, United Kingdom; Public Health Scotland, National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom.
Res Social Adm Pharm. 2022 May;18(5):2757-2777. doi: 10.1016/j.sapharm.2021.07.010. Epub 2021 Jul 14.
An aging population and rising multi-morbidity has shifted healthcare provision from secondary to primary care. Pharmacy-led services have been introduced to support this. The development of an outcomes framework for these services would facilitate conclusions to be drawn on their effectiveness.
To identify outcomes used to evaluate pharmacy-led medication therapy and disease management services within primary care settings to develop an outcomes framework for future studies.
An umbrella literature review was conducted. MEDLINE, EMBASE, The Cochrane Library and PsycINFO were searched in June 2020 to identify relevant articles. Eligible reviews were those including studies published from 2010 onwards which reported on the outcomes of pharmacy-led medication therapy and disease management services within primary care, excluding community pharmacy settings. Data were extracted and a content analysis, guided by the ECHO model, stratified the outcomes into four areas: economic, clinical, humanistic and service.
Twenty-four reviews covering 52 unique studies were identified. Pharmacy-led services included: medication reviews (n=24, 46.2%), disease and therapy management (n=17, 32.7%), educational services (n=6, 11.5%), medicines reconciliation (n=3, 5.8%), and medication compliance support (n=1, 1.9%). Services were commonly targeted towards endocrine (n=23, 44.2%) or cardiovascular diseases (n=20, 38.5%). Outcomes most commonly explored were clinical (n=38, 73.1%) and service outcomes (n=37, 71.2%), followed by humanistic (n=23, 44.2%) and economic outcomes (n=13, 25.0%). Overall, 17 sub-categories of outcomes were identified; common sub-categories were: disease indicators [clinical]; medication use and healthcare utilisation [service]; adherence to medicines [humanistic]; and healthcare costs [economic].
The findings informed the development of an outcomes framework to guide the evaluation of medication therapy and disease management services, and facilitate international standardised outcome measures within primary care pharmacy to be developed. This could help offer vital evidence on the effectiveness of these services to ensure the pharmacy workforce is working optimally to support primary care.
人口老龄化和多种疾病的增加促使医疗保健从二级医疗转向初级保健。药剂师主导的服务已经被引入以支持这一转变。为这些服务制定一个结果框架将有助于对其有效性得出结论。
确定用于评估初级保健环境中药剂师主导的药物治疗和疾病管理服务的结果，以开发一个未来研究的结果框架。
进行了一项伞式文献综述。2020 年 6 月，在 MEDLINE、EMBASE、Cochrane 图书馆和 PsycINFO 中搜索了相关文章，以确定符合条件的综述，这些综述包括自 2010 年以来发表的报告初级保健中药剂师主导的药物治疗和疾病管理服务结果的研究，不包括社区药房环境。提取数据，并根据 ECHO 模型进行内容分析，将结果分为四个领域：经济、临床、人性化和服务。
确定了 24 篇综述，涵盖了 52 项独特的研究。药剂师主导的服务包括：药物审查（n=24，46.2%）、疾病和治疗管理（n=17，32.7%）、教育服务（n=6，11.5%）、药物重整（n=3，5.8%）和药物依从性支持（n=1，1.9%）。服务通常针对内分泌（n=23，44.2%）或心血管疾病（n=20，38.5%）。最常探讨的结果是临床（n=38，73.1%）和服务结果（n=37，71.2%），其次是人性化（n=23，44.2%）和经济结果（n=13，25.0%）。总体而言，确定了 17 个子类别的结果；常见的子类别包括：疾病指标[临床]；药物使用和医疗保健利用[服务]；药物依从性[人性化]；和医疗保健成本[经济]。
这些发现为制定药物治疗和疾病管理服务的评估指导方针提供了信息，并促进了初级保健药房内国际标准化结果测量的发展。这有助于为这些服务的有效性提供重要证据，以确保药剂师的工作效率达到最佳，以支持初级保健。
