OBJECTIVES: To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management.
DESIGN: Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: None
STUDY DESIGN: randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series.
INTERVENTION: any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language.
RESULTS: 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 'strong', 4 'moderate' and 9 'weak'. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions.
CONCLUSIONS: Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services.
BACKGROUND: Positive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery.
OBJECTIVES: To: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas.
METHODS: Empirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies.
RESULTS: A total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used.
CONCLUSIONS: There is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized.
Background Pharmacists' counseling has improved health-related outcomes in many acute and chronic conditions. Several studies have shown how pharmacists have been contributing to reduce morbidity and mortality related to drug-therapy (MMRDT). However, there still is a lack of reviews that assemble evidence-based clinical pharmacists' counseling. Equally, there is also a need to understand structure characteristics, processes and technical contents of these clinical services. Aim of the review To review the structure, processes and technical contents of pharmacist counseling or education reported in randomized controlled trials (RCT) that had positive health-related outcomes. Methods We performed a systematic search in specialized databases to identify RCT published between 1990 and 2013 that have evaluated pharmacists' counseling or educational interventions to patients. Methodological quality of the trials was assessed using the Jadad scale. Pharmacists' interventions with positive clinical outcomes (p < 0.05) were evaluated according to patients' characteristics, setting and timing of intervention, reported written and verbal counseling. Results 753 studies were found and 101 RCT matched inclusion criteria. Most of the included RCTs showed a Jadad score between two (37 studies) and three (32 studies). Pharmacists were more likely to provide counseling at ambulatories (60 %) and hospital discharge (25 %); on the other hand pharmacists intervention were less likely to happen when dispensing a medication. Teaching back and explanations about the drug therapy purposes and precautions related to its use were often reported in RCT, whereas few studies used reminder charts, diaries, group or electronic counseling. Most of studies reported the provision of a printed material (letter, leaflet or medication record card), regarding accessible contents and cultural-concerned informations about drug therapy and disease. Conclusion Pharmacist counseling is an intervention directed to patients' health-related needs that improve inter-professional and inter-institutional communication, by collaborating to integrate health services. In spite of reducing MMRDT, we found that pharmacists' counseling reported in RCT should be better explored and described in details, hence collaborating to improve medication-counseling practice among other countries and settings.
BACKGROUND: Tobacco use remains the leading cause of preventable morbidity and mortality. Implementation of tobacco use cessation interventions however requires strategies that reach large proportions of the population. Pharmacy personnel are therefore a potential human resource for delivering tobacco use cessation interventions.
OBJECTIVE: This review aimed to identify, describe and synthesis currently available evidence on the effectiveness of tobacco use cessation interventions delivered by pharmacy personnel.
METHODS: The following electronic databases were searched for studies published until May 2012: MEDLINE, EMBASE, PSYCINFO, Cochrane Library, Web of Knowledge and the Current Controlled Trials Register. This review considered controlled clinical trials and randomized controlled trials, which were comparing any pharmacy personnel delivered tobacco use cessation intervention to no treatment, usual care or other active treatments. The outcomes of interest were: abstinence (e.g., point prevalence; continuous abstinence) and relapse (e.g., time to relapse) as measured by the respective studies. The results were not pooled due to high levels of clinical heterogeneity.
RESULTS: Ten eligible studies with a total of 20,133 participants were identified. Results suggest pharmacy personnel delivered non-pharmacological interventions offering behavioral counseling or support for tobacco use cessation could be beneficial, particularly from 6 months follow-up onwards. Combining these non-pharmacological with pharmacological interventions could also be beneficial. The results for the effectiveness of nicotine replacement therapy (NRT) were mixed with some findings suggesting intervention benefits, and others suggesting no clear benefit.
CONCLUSIONS: Pharmacy personnel-delivered non-pharmacological tobacco use cessation interventions offering behavioral counseling or support, and those combining these non-pharmacological interventions with NRT/pharmacological approaches, are potentially effective. No clear benefit has been demonstrated on pharmacy personnel-delivered NRT interventions. However, these findings are based on a very limited number of studies and hence more evidence is needed before more robust conclusions can be made.
WHAT IS KNOWN AND OBJECTIVE: With the emerging and promising role of healthcare professionals in implementing smoking cessation services, community pharmacists, in particular, can play a pivotal role. The aim of this meta-analysis is to evaluate the effectiveness of smoking cessation interventions delivered by community pharmacists in assisting smokers to quit.
METHODS: PubMed, EMBASE, Scopus, International Pharmaceutical Abstracts and ISI Web of Knowledge were searched from inception to May 2013. Original research articles were selected for review, if they addressed the effectiveness of pharmacy-based interventions in smokers vs. a control group and reported smoking abstinence rates as an outcome. Obtained studies were assessed for methodological quality using the Cochrane Effective Practice and Organization of Care Group risk of bias tool. The primary outcome of measure was smoking abstinence based on the 'most rigorous criterion'. Pooled relative risks (RR) with 95% confidence interval (CI) were estimated using the Dersimonian and Laird random-effects models. Corresponding subgroup met-analysis was performed.
RESULTS: Of the 1168 articles extracted, five studies (three randomized controlled trials and two controlled before-after studies) met the inclusion criteria, involving a total of 1426 smokers. Pharmacist interventions showed better abstinence rates as compared with controls (RR 2·21, 95% CI 1·49-3·29). Compared with the control group, the RR (95% CI) in the intervention group was 3·21 (1·81-5·72) for clinically validated abstinence and 1·66 (1·08-2·54) for self-reported abstinence. In the intervention group, the RR for short-term and long-term abstinence was 2·48 (1·15-5·31) and 2·40 (1·37-4·23), respectively.
WHAT IS NEW AND CONCLUSIONS: Pharmacist-led interventions can significantly impact abstinence rates in smokers. Health policymakers should direct incentives for community pharmacists to provide such services.
To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management.
DESIGN:
Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES:
None
STUDY DESIGN:
randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series.
INTERVENTION:
any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language.
RESULTS:
19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 'strong', 4 'moderate' and 9 'weak'. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions.
CONCLUSIONS:
Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services.
