Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
Health Information and Quality Authority, Dublin, Ireland.
BMC Prim Care. 2023 Feb 6;24(1):41. doi: 10.1186/s12875-022-01952-z.
Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein 'pharmacist integration') may improve medications management and patient outcomes. This systematic review assessed the effectiveness and costs of pharmacist integration.
A systematic search of ten databases from inception to January 2021 was conducted. Studies that evaluated the effectiveness or cost of pharmacist integration were included. Eligible interventions were those that targeted medications optimization compared to usual GP care without pharmacist integration (herein 'usual care'). Primary outcomes were PIP (as measured by PIP screening tools) and number of prescribed medications. Secondary outcomes included health-related quality of life, health service utilization, clinical outcomes, and costs. Randomised controlled trials (RCTs), non-RCTs, interrupted-time-series, controlled before-after trials and health-economic studies were included. Screening and risk of bias using Cochrane EPOC criteria were conducted by two reviewers independently. A narrative synthesis and meta-analysis of outcomes where possible, were conducted; the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.
In total, 23 studies (28 full text articles) met the inclusion criteria. In ten of 11 studies, pharmacist integration probably reduced PIP in comparison to usual care (moderate certainty evidence). A meta-analysis of number of medications in seven studies reported a mean difference of -0.80 [-1.17, -0.43], which indicated pharmacist integration probably reduced number of medicines (moderate certainty evidence). It was uncertain whether pharmacist integration improved health-related quality of life because the certainty of evidence was very low. Twelve health-economic studies were included; three investigated cost effectiveness. The outcome measured differed across studies limiting comparisons and making it difficult to make conclusions on cost effectiveness.
Pharmacist integration probably reduced PIP and number of medications however, there was no clear effect on other patient outcomes; and while interventions in a small number of studies appeared to be cost-effective, further robust, well-designed cluster RCTs with economic evaluations are required to determine cost-effectiveness of pharmacist integration.
CRD42019139679.
多种药物治疗和潜在的不适当处方（PIP）给患者带来了相当大的负担，也给全科医生（GP）带来了挑战。药剂师整合到全科实践中（以下简称“药剂师整合”）可以改善药物管理和患者的结局。本系统评价评估了药剂师整合的有效性和成本。
从开始到 2021 年 1 月，对 10 个数据库进行了系统搜索。纳入评估药剂师整合有效性或成本的研究。合格的干预措施是针对与没有药剂师整合的常规 GP 护理相比药物优化的干预措施（以下简称“常规护理”）。主要结局是 PIP（通过 PIP 筛查工具测量）和开具的药物数量。次要结局包括健康相关生活质量、卫生服务利用、临床结局和成本。纳入随机对照试验（RCT）、非 RCT、中断时间序列、对照前后试验和健康经济学研究。两名评审员独立进行了 Cochrane EPOC 标准的筛查和偏倚风险评估。对可能的结局进行了叙述性综合和荟萃分析；使用推荐、评估、制定和评价方法评估证据的确定性。
共有 23 项研究（28 篇全文文章）符合纳入标准。在 11 项研究中的 10 项中，与常规护理相比，药剂师整合可能降低了 PIP（中等确定性证据）。对 7 项研究中药物数量的荟萃分析报告的平均差异为-0.80[-1.17，-0.43]，这表明药剂师整合可能减少了药物数量（中等确定性证据）。药剂师整合是否改善健康相关生活质量尚不确定，因为证据的确定性非常低。纳入了 12 项健康经济学研究；其中 3 项研究了成本效益。由于研究之间的结果测量存在差异，限制了比较，因此难以就成本效益得出结论。
药剂师整合可能降低了 PIP 和药物数量，但对其他患者结局没有明显影响；虽然少数研究中的干预措施似乎具有成本效益，但需要进一步进行稳健、精心设计的集群 RCT 并进行经济评估，以确定药剂师整合的成本效益。
CRD42019139679。
