Clinical pharmacy services for tuberculosis management: a systematic review

Abstract

Objective: This study aims to systematically review the content and potential effects of clinical pharmacy services in tuberculosis (TB) care management.Methods: Searches were performed in PubMed, Embase, Cochrane, Scopus, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study characteristics and outcomes were extracted, and clinical pharmacy service components were characterized using the Descriptive Elements of Pharmacist Intervention Characterization Tool.Results: Twenty articles were included for full-text assessment, of which 10 fulfilled inclusion criteria, comprising 1,168 patients (N = 39 to 258 per study). These articles included five prospective cohort studies, two case–control studies, two quasi-experimental studies, and one cross-sectional study. Intervention foci within clinical pharmacy services were medication adherence (50%), medication safety (40%), education to patients/caregivers regarding needs/beliefs (30%), optimizing medication/therapy effectiveness (30%), emphasizing HRQoL (10%), and drug selections (10%). The three most frequently applied interventions were drug information/patient counseling (80%), adverse drug reaction monitoring (50%), and drug use evaluation (20%). Based on the World Health Organization (WHO) outcome classification, treatment success ranged from 72% to 93%, with higher cure outcomes (53%–86%) than treatment completion (7%–19%). Other outcomes, including isoniazid metabolites, medication counts, sputum conversion, adherence/compliance, knowledge, and quality of life, were better in the intervention group than those in comparator groups, and/or they improved over time. Risk of bias analysis indicated that the included studies were not comparable to a randomized clinical trial.Conclusion: Clinical pharmacy services as single or composite interventions potentially improve TB outcomes, but its evidence is still inconsistent and limited due to the lack of randomized controlled studies using the WHO outcome classification.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199028, identifier CRD42020199028.

Impact of pharmaceutical care interventions in improving clinical outcomes among patients with pulmonary tuberculosis: a systematic review

“…The pivotal role of pharmacists in TB control initiatives aligns with broader efforts to engage all healthcare professionals in the fight against TB. As the most accessible healthcare providers and among the most trusted, pharmacists are uniquely positioned to contribute significantly to TB management (Iskandar et al, 2023 ; Wong et al, 2023 ; World Health Organization, International Pharmaceutical Federation, 2011 ). The primary objective of this systematic review was to evaluate the impact of PC interventions on enhancing clinical outcomes in individuals diagnosed with TB.…”

“…Pharmacist involvement in TB programmes can improve continuity of care and bridge the gap between symptoms detection and monitoring of treatment (Wong et al, 2023 ). In addition, they play a crucial role in optimising therapy of patients after TB diagnosis, ensuring that appropriate patient-centred care is given, and minimising anti-TB drugs-related adverse effects (Iskandar et al, 2023 ; Miller & Goodman, 2020 ). Moreover, pharmacist play a role in directly observed therapy (DOT) strategy, which is a cornerstone in improving the outcomes of TB care (Wong et al, 2023 ).…”

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

“…Non-adherence to treatment is a significant factor causing inadequate drug effectiveness and adverse reactions, leading to drug resistance. 24 25 Pharmacist intervention through CPS can address these issues, [25][26][27][28] but its implementation is challenging 18 and requires a comprehensive and collaborative approach focusing on the unique traits of each patient. 2 7 Despite the limited number of patients receiving collaborative TB care, 9 we found that patients were the most likely to receive CPS, indicating their high involvement with pharmacists, and this could improve TB understanding and the quality of care, 29 30 motivating them to adhere to their treatment.…”

Pharmacists’ Role in Global TB Elimination: Practices, Pitfalls, and Potential

“…Previous systematic reviews focused on pharmacists’ role in treating TB [ 16 ]; however, there is a paucity of studies to focus on pharmacist roles in overall TB elimination efforts, particularly regarding actions beyond the core of pharmaceutical care, i.e., the interpersonal level.…”