Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses
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| Natura: | Artículo científico |
| Lingua: | en |
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Centro de investigaciones y Publicaciones Farmacéuticas
2020
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| author | Priscila L. Nassur |
| author_facet | Priscila L. Nassur |
| contents | Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses Priscila L. Nassur Marcela Forgerini Patrícia C. Mastroianni Rosa C. Lucchetta Medicina Cost Meta Brazil Pharmacies Pharmacists Objective: To map the clinical pharmacy services conducted in Brazil, their characteristics, outcomes, and process measures in general population, as well as the assessment of the clinical impact on people with cardiometabolic diseases (cardiovascular diseases and metabolic diseases).Methods: A systematic scoping review and meta-analysis were conducted. The electronic searches were re-run in March 2020. To the clinical impact assessment, meta-analyses of cardiometabolic outcomes (i.e., change of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total cholesterol, glycated hemoglobin (HbA1c), fasting glycemia, LDL-, and HDL-cholesterol) were led. The risk of bias was assessed with the Cochrane Collaboration tools.Results: 71 studies were identified (7,402 patients), being the majority quasi-experimental studies (n=41) and published by research groups of Southeast Brazil (n=33). Medication therapy management (n=62) was the most frequent clinical pharmacy service, performed on outpatient setting (n=45), with adults or elderly people (n=58) with hypertension (n=18) or diabetes (n=10). Process measures (n=58) (e.g. resolution of drug related-problem) were widely used as indicator, followed by clinical (n=44) (e.g. change in SBP), humanistic (n=12) (e.g. change in quality-of-life score assessed by Short-Form 36 Health Survey Questionnaire), and economic outcomes (n=3) (incremental cost-effectiveness ratio for reduction in HbA1c). Regarding the assessment of clinical impact of the services, 20 studies were included in meta-analyses, showing improvement in most cardiometabolic outcomes when considered individual studies. However, the evidence presents high risk of bias, high heterogeneity (median 67-90%) and imprecision, contributing to wide prediction intervals and low reliability.Conclusions: A predominance of studies on cardiometabolic diseases, process measures, and clinical outcomes were identified. Considering the assessment of the clinical impact of clinical pharmacy services in cardiometabolic diseases, an improvement in most cardiometabolic outcomes was showed, however, with low confidence and wide prediction interval. Therefore, development of larger studies with low risk of bias and major homogeneity is necessary for a better comprehension of cl 2020 artículo científico 1885-642X https://www.redalyc.org/articulo.oa?id=69065617013 https://www.redalyc.org/journal/690/69065617013/ https://www.redalyc.org/journal/690/69065617013/html/ https://www.redalyc.org/journal/690/69065617013/69065617013.epub https://www.redalyc.org/journal/690/69065617013/movil 10.18549/PharmPract.2020.4.2131 en http://www.redalyc.org/revista.oa?id=690 Pharmacy Practice application/pdf Centro de investigaciones y Publicaciones Farmacéuticas Pharmacy Practice (España) Num.4 Vol.18 |
| format | Artículo científico |
| id | redalyc_69065617013 |
| institution | Redalyc |
| language | en |
| publishDate | 2020 |
| publisher | Centro de investigaciones y Publicaciones Farmacéuticas |
| spellingShingle | Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses Priscila L. Nassur Medicina Cost Meta Brazil Pharmacies Pharmacists Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses Priscila L. Nassur Marcela Forgerini Patrícia C. Mastroianni Rosa C. Lucchetta Medicina Cost Meta Brazil Pharmacies Pharmacists Objective: To map the clinical pharmacy services conducted in Brazil, their characteristics, outcomes, and process measures in general population, as well as the assessment of the clinical impact on people with cardiometabolic diseases (cardiovascular diseases and metabolic diseases).Methods: A systematic scoping review and meta-analysis were conducted. The electronic searches were re-run in March 2020. To the clinical impact assessment, meta-analyses of cardiometabolic outcomes (i.e., change of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total cholesterol, glycated hemoglobin (HbA1c), fasting glycemia, LDL-, and HDL-cholesterol) were led. The risk of bias was assessed with the Cochrane Collaboration tools.Results: 71 studies were identified (7,402 patients), being the majority quasi-experimental studies (n=41) and published by research groups of Southeast Brazil (n=33). Medication therapy management (n=62) was the most frequent clinical pharmacy service, performed on outpatient setting (n=45), with adults or elderly people (n=58) with hypertension (n=18) or diabetes (n=10). Process measures (n=58) (e.g. resolution of drug related-problem) were widely used as indicator, followed by clinical (n=44) (e.g. change in SBP), humanistic (n=12) (e.g. change in quality-of-life score assessed by Short-Form 36 Health Survey Questionnaire), and economic outcomes (n=3) (incremental cost-effectiveness ratio for reduction in HbA1c). Regarding the assessment of clinical impact of the services, 20 studies were included in meta-analyses, showing improvement in most cardiometabolic outcomes when considered individual studies. However, the evidence presents high risk of bias, high heterogeneity (median 67-90%) and imprecision, contributing to wide prediction intervals and low reliability.Conclusions: A predominance of studies on cardiometabolic diseases, process measures, and clinical outcomes were identified. Considering the assessment of the clinical impact of clinical pharmacy services in cardiometabolic diseases, an improvement in most cardiometabolic outcomes was showed, however, with low confidence and wide prediction interval. Therefore, development of larger studies with low risk of bias and major homogeneity is necessary for a better comprehension of cl 2020 artículo científico 1885-642X https://www.redalyc.org/articulo.oa?id=69065617013 https://www.redalyc.org/journal/690/69065617013/ https://www.redalyc.org/journal/690/69065617013/html/ https://www.redalyc.org/journal/690/69065617013/69065617013.epub https://www.redalyc.org/journal/690/69065617013/movil 10.18549/PharmPract.2020.4.2131 en http://www.redalyc.org/revista.oa?id=690 Pharmacy Practice application/pdf Centro de investigaciones y Publicaciones Farmacéuticas Pharmacy Practice (España) Num.4 Vol.18 |
| title | Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses |
| topic | Medicina Cost Meta Brazil Pharmacies Pharmacists |
| url | https://www.redalyc.org/articulo.oa?id=69065617013 https://www.redalyc.org/journal/690/69065617013/ https://www.redalyc.org/journal/690/69065617013/html/ https://www.redalyc.org/journal/690/69065617013/69065617013.epub https://www.redalyc.org/journal/690/69065617013/movil |