Naseralallah Lina, Koraysh Somaya, Aboujabal Bodoor, Alasmar May
Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar.
School of Pharmacy, Institute of Clinical Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Birmingham, UK.
Ther Adv Drug Saf. 2024 Jul 31;15:20420986241260169. doi: 10.1177/20420986241260169. eCollection 2024.
The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings.
To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings.
A systematic review and meta-analysis.
We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs).
Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies ( = 21; 84%) were of moderate quality.
Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.
围手术期是一个独特且具有挑战性的环境，需要协调复杂的流程并让整个护理团队参与其中。药剂师的执业范围一直在不断演变，以患者为中心，并扩展到包括围手术期环境在内的各种环境。
批判性地评估、综合并呈现有关药剂师主导的干预措施对围手术期环境中临床重要结局的特征和影响的现有证据。
系统评价和荟萃分析。
我们检索了从索引起始到2023年9月的PubMed、Embase和CINAHL。纳入的研究比较了药剂师主导的干预措施与围手术期常规护理相比对临床重要结局（如住院时间、再入院）的有效性。两名独立的审阅者使用DEPICT-2（药剂师干预特征描述工具的描述性要素）提取数据，并使用克劳批判性评价（CCAT）进行质量评估。采用随机效应模型估计总体效应[二分法的优势比（OR）和连续数据的标准化均值差（SMD）]，并给出95%置信区间（CI）。
25项研究符合条件，20项（80%）采用非对照研究设计。大多数干预措施是多成分的，并且在围手术期是持续的。干预成分包括临床药学服务（如药物管理/优化、用药核对、出院指导）以及对医疗保健专业人员的教育。虽然一些研究对干预措施的制定和过程进行了简要描述，但只有一项研究报告了干预措施制定的理论基础。汇总分析表明，与常规护理相比，药剂师护理对住院时间（11项研究；SMD -0.09；95% CI -0.49至-0.15）和全因再入院（8项研究；OR 0.60；95% CI 0.39 - 0.91）有显著影响。纳入的大多数研究（n = 21；84%）质量中等。
药剂师主导的干预措施在改善围手术期环境中的临床重要结局方面是有效的；然而，大多数研究质量中等。研究缺乏利用理论来制定干预措施；因此，尚不清楚基于理论的干预措施是否比没有理论要素的干预措施更有效。未来的研究应优先开展和评估针对整个手术护理路径的多方面理论指导的药剂师干预措施。
