Intervention effectiveness by pharmacists integrated within an interdisciplinary health team on chronic complex patients

Abstract

Background Nowadays, it is difficult to establish a specific method of intervention by the pharmacist and its clinical repercussions. Our aim was to identify interventions by pharmacists integrated within an interdisciplinary team for chronic complex patients (CCPs) and determine which of them produce the best results. Methods A systematic review (SR) was performed based on PICO(d) question (2008–18): (Population): CCPs; (Intervention): carried out by health system pharmacists in collaboration with an interdisciplinary team; (Comparator): any; (Outcome): clinical and health resources usage outcomes; (Design): meta-analysis, SR and randomized clinical trials. Results Nine articles were included: one SR and eight randomized clinical trials. The interventions consisted mainly in putting in order the pharmacotherapy and the review of the medication adequacy, medication reconciliation in transition of care and educational intervention for health professionals. Only one showed significant improvements in mortality (27.9% vs. 38.5%; HR = 1.49; P = 0.026), two in health-related quality of life [according to EQ-5D (European Quality of Life—5 Dimensions) and EQ-VAS (European Quality of Life—Visual Analog Scale) tests] and four in other health-related results (subjective self-assessment scales, falls or episodes of delirium and negative health outcomes associated with medication). Significant differences between groups were found in hospital stay and frequency of visits to the emergency department. No better results were observed in hospitalization rate. Otherwise, one study measured cost utility and found a cost of €45 987 per quality-adjusted life year gained due to the intervention. Conclusions It was not possible to determine with certainty which interventions produce the best results in CCPs. The clinical heterogeneity of the studies and the short follow-up of most studies probably contributed to this uncertainty.

Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review

“…We found no evidence that any pharmacist intervention reduces mortality at any time point. These results were also found in other studies [8,9,25,60]. This may be related to the high complexity of the patients studied, often with limited life expectancies, where the aim of care is usually to preserve or improve QoL or maintain function.…”

“…Our findings were heterogeneous both in the characteristics of the intervention and on the impact on outcomes. Some studies explored the impact of simple interventions with few professionals involved [25,45,57,58], while other planned complex interventions where the pharmacist was part of a geriatric interdisciplinary team [25,28]. In other studies, pharmacists only acted on demand [56,59].…”

“…This issue remains clearly unexplored. Moreover, the exact interventions conducted by pharmacists in different studies are heterogeneous, which makes it difficult to determine which interventions produce the best results in complex older patients [25].…”

Quality measures of clinical pharmacy services during transitions of care

“…Ongoing gaps include, but are not limited to, variability in outcome definitions, data collection processes, measurement of outcome effects from single vs comprehensive or sequential interventions, and isolation of direct effects of specific pharmacy services together with or without other non‐pharmacy services. Overall, despite heterogeneities in patient populations, services, processes, and interventions, many examples of common HCU metrics have been represented 65‐70 …”