A Role for Primary Care Pharmacists in the Management of Inflammatory Bowel Disease? Lessons from Chronic Disease: A Systematic Review

Abstract

Background and aims: Chronic disease, particularly inflammatory bowel disease (IBD), requires a multifaceted approach to managing patients, but it is apparent that primary care pharmacists are being underutilized. To demonstrate the benefits of pharmacist interventions in primary care, a systematic review was conducted of interventions in asthma and type 2 diabetes where pharmacists have a defined role in chronic disease management. We also explored potential opportunities for primary care pharmacists to deliver tailored care to patients with inflammatory bowel disease. Methods: The search strategy retrieved original research articles from seven databases; eligible articles were assessed for inclusion. Quality appraisal was performed independently by two reviewers. Results: Thirty-seven included studies were grouped into four categories of interventions: education/counseling (43%), medication management (34%), monitoring/follow-up (17%), and screening/risk prevention (6%). Education plus counseling was reported as the main intervention delivered by pharmacists. Three measurable outcomes were identified: clinical, humanistic (e.g., quality of life), and economic. Clinical outcomes (63%) were reported more commonly than humanistic (26%) and economic (11%) outcomes. Pharmacist interventions led to statistically significant improvements in control of disease, severity, and medication adherence, as well as improvements in overall patient satisfaction, quality of life among patients with asthma and type 2 diabetes. Conclusion: As one of the most accessible sources of primary health care, pharmacists are well-placed to minimize the impact of chronic diseases on patients and communities. Evidence suggests there are opportunities for primary care pharmacists to play a more active role in the management of chronic diseases such as IBD.

A survey of pharmacists' roles in gastroenterology and hepatology

“…In concordance with existing literature, pharmacists are still practicing in IBD and hepatitis; however, pharmacists are also managing other GI/liver-related conditions. 15,[17][18][19] While this survey did not assess how much time is allocated or the extent of services provided in managing each individual disease state, we were able to identify that the need for pharmacist involvement in GI/liver has primarily been recognized in outpatient clinic settings. This is likely being driven by prescription drug expenditures, which has been increasing in community and clinic settings.…”

“…With the growing incidence of GI/liver diagnoses and use of high-cost medications, the inclusion of clinical pharmacists in this space is likely to be very beneficial. 9,[13][14][15][16] While existing studies highlight clinical pharmacists' involvement with HCV and IBD, it is unclear how many pharmacists are practicing in these areas, the extent of their roles, and what other therapeutic conditions within GI/liver are being managed. 11,15,[17][18][19] Understanding this practice landscape will help solidify the role of the pharmacist to participate in a clinical capacity as part of the care team, foster collaborations, and promote pharmacy practice in this specialty.…”

“…9,[13][14][15][16] While existing studies highlight clinical pharmacists' involvement with HCV and IBD, it is unclear how many pharmacists are practicing in these areas, the extent of their roles, and what other therapeutic conditions within GI/liver are being managed. 11,15,[17][18][19] Understanding this practice landscape will help solidify the role of the pharmacist to participate in a clinical capacity as part of the care team, foster collaborations, and promote pharmacy practice in this specialty. The number of individuals needing HCV treatment remains large as it is estimated that only 43% of patients have cleared the infection, which is below Department of Health and Human Services' goal to reach 80% eradication by 2030.…”

Effects of the COVID-19 Pandemic on Physical Activity in Chronic Diseases: A Systematic Review and Meta-Analysis

“…These conditions are produced by a combination of environmental, behavioral, genetic, and physiological factors [ 5 ]. Chronic diseases are the main causes of disability and mortality globally and affect 5–8% of the population in developed countries [ 6 , 7 ]. It has been estimated that 60% of deaths worldwide and 75% of public health expenditure are caused by chronic diseases [ 8 , 9 ].…”

Reply

“… 2 Interestingly, in patients with other chronic diseases, such as asthma and type 2 diabetes, pharmacist interventions led to better disease control and improvements in patient satisfaction and quality of life. 3 In addition, during the current health emergency setting, pharmacists could assess compatibility and possible interactions between IBD drugs (eg, steroids, immunosuppressants, biologics, and small molecules) and Coronavirus Disease 2019 (COVID-19) therapy in subjects with suspected severe acute respiratory syndrome coronavirus 2 infection and in those with a confirmed COVID-19 diagnosis. Moreover, they could also monitor the pharmacovigilance data, excluding any late adverse events.…”