Zhang Puwen, Yang Mengting, He Siyi, Li Xiayan, Lang Bingchen, Zeng Linan, Zhang Lingli
Department of Pharmacy/Evidence-Based Pharmacy Center, Children's Medicine Key Laboratory of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China.
National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and in Vivo Correlation, Chengdu, China.
J Med Internet Res. 2025 Jul 2;27:e64073. doi: 10.2196/64073.
Telepharmaceutical services (TPS) led by pharmacists, an emerging telehealth service, improve access to medical services and enable patients to receive specialized services in areas with limited resources. With a lower risk of infection and no restriction of isolation measures, TPS showed great potential during the COVID-19 pandemic. However, whether the effectiveness of TPS changed before and after the outbreak of the COVID-19 pandemic remained unclear.
This study aimed to evaluate the effectiveness of TPS, compare the effectiveness before and after the outbreak of the COVID-19 pandemic, and explore whether the effectiveness changed over time.
We searched PubMed, Embase (Ovid), SinoMed, China National Knowledge Infrastructure, Wanfang, and VIP databases for randomized controlled trials that evaluated the effectiveness of TPS. The search covered studies published from inception to October 24, 2023. Eligible studies were conducted before May 5, 2023, when the World Health Organization (WHO) declared the end of the COVID-19 pandemic as a Public Health Emergency of International Concern. We used the random-effect model to pool the results and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the certainty of evidence. To explore whether the effectiveness of TPS changed over time, we applied subgroup analyses (studies conducted before December 31, 2019, and studies conducted after January 1, 2020). Using the independent-sample z test, we compared the effectiveness of TPS between the 2 subgroups. When a significant difference arose between them, we conducted a meta-regression analysis to further evaluate the trend of effectiveness over time.
In addition, 40 studies were finally included. Compared with no TPS or usual care (ie, face-to-face pharmaceutical services), TPS probably increased patient medication adherence (risk difference [RD] 0.15, 95% CI 0.09-0.20, moderate certainty), and may reduce the occurrence of adverse events (RD -0.10, 95% CI -0.18 to -0.02, low certainty) and improve the proportion of patients who were satisfied with medication (RD 0.16, 95% CI 0.05-0.26, low certainty). Moderate to high evidence indicated that patients accepting TPS probably achieved superior management of diabetes and hypertension. The effectiveness of TPS was not significantly different before and after the outbreak of the COVID-19 pandemic except for medication adherence (RD 0.12, 95% CI 0.03-0.21, P=.007), which also increased over time (coefficient=0.01, 95% CI 0.01-0.02, P<.001).
TPS probably improved patient medication adherence and may lead to better satisfaction and the incidence of adverse events. The effectiveness of TPS in general did not change after the outbreak of the COVID-19 pandemic.
PROSPERO CRD42023487476; https://tinyurl.com/3s47enj6.
由药剂师主导的远程药学服务（TPS）是一种新兴的远程医疗服务，可改善医疗服务的可及性，并使患者能够在资源有限的地区获得专业服务。由于感染风险较低且不受隔离措施限制，TPS在新冠疫情期间显示出巨大潜力。然而，新冠疫情爆发前后TPS的有效性是否发生变化仍不清楚。
本研究旨在评估TPS的有效性，比较新冠疫情爆发前后的有效性，并探讨有效性是否随时间变化。
我们在PubMed、Embase（Ovid）、中国生物医学文献数据库、中国知网、万方和维普数据库中检索评估TPS有效性的随机对照试验。检索涵盖从数据库建库至2023年10月24日发表的研究。纳入2023年5月5日前开展的符合条件的研究，当时世界卫生组织宣布新冠疫情不再构成国际关注的突发公共卫生事件。我们采用随机效应模型汇总结果，并使用推荐分级的评估、制定与评价（GRADE）系统评估证据的确定性。为探讨TPS的有效性是否随时间变化，我们进行亚组分析（2019年12月31日前开展的研究和2020年1月1日后开展的研究）。使用独立样本z检验比较两个亚组之间TPS的有效性。当二者出现显著差异时，我们进行meta回归分析以进一步评估有效性随时间的变化趋势。
此外，最终纳入40项研究。与未接受TPS或常规护理（即面对面药学服务）相比，TPS可能提高患者的用药依从性（风险差[RD]0.15，95%CI 0.09 - 0.20，中等确定性），并可能降低不良事件的发生率（RD -0.10，95%CI - 0.18至 -0.02，低确定性），提高患者对用药的满意度（RD 0.16，95%CI 0.05 - 0.26，低确定性）。中到高等级证据表明，接受TPS的患者可能在糖尿病和高血压管理方面表现更优。除用药依从性外，新冠疫情爆发前后TPS的有效性无显著差异（RD 0.12，95%CI 0.03 - 0.21，P = 0.007），用药依从性也随时间增加（系数 = 0.01，95%CI 0.01 - 0.02，P < 0.001）。
TPS可能提高患者的用药依从性，并可能带来更高的满意度和更低的不良事件发生率。新冠疫情爆发后，TPS的总体有效性未发生变化。
PROSPERO CRD42023487476；https://tinyurl.com/3s47enj6 。
